Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker |
NPI | 1003076555 |
---|---|
Provider Name | Tamara Ruth Johnson |
First Address | Tucson, AZ 85735-5008 |
Second Address | Tucson, AZ 85735-5008 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2008 |
Last Update Date | 09/06/2008 |