Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003327123 |
---|---|
Provider Name | Palmer W Johnson |
First Address | Colorado Springs, CO 80932-0100 |
Second Address | Colorado Springs, CO 80909-8001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2017 |
Last Update Date | 16/10/2017 |