Johnson, Jacqueline

Johnson, Jacqueline is an individual health care provider with primary practice located at 829 Chief Eddie Hoffman Hwy , Bethel AK 99559. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Johnson, Jacqueline can be contacted via phone (907) 543-6100.

Contact Information

Primary practice address
829 Chief Eddie Hoffman Hwy Bethel AK 99559
Fax: (907) 543-6008
Website:

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 1041C0700X

Profile Details

NPI number 1821219130
LBN Legal business name Johnson, Jacqueline
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date May 2nd, 2007
Last updated Jul 9th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1821219130 NPPES
Alaska MEDICAID MH0150

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