| Jody Johnson Lifespan Therapy, Llc | |
|
308 N Locust St Ste 401 Grand Island NE 68801-5901 | |
| (402) 225-6360 | |
| (402) 998-1565 |
| Full Name | Jody Johnson Lifespan Therapy, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 308 N Locust St Ste 401, Grand Island, Nebraska |
| Authorized Official Name and Position | Jody Johnson (OWNER) |
| Authorized Official Contact | 3083808555 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jody Johnson Lifespan Therapy, Llc 1107 Nebraska Ave Grand Island NE 68801-8103 Ph: (308) 380-8555 | Jody Johnson Lifespan Therapy, Llc 308 N Locust St Ste 401 Grand Island NE 68801-5901 Ph: (402) 225-6360 |
| NPI Number | 1396331781 |
|---|---|
| Provider Enumeration Date | 12/19/2020 |
| Last Update Date | 12/23/2020 |
| Certification Date | 12/23/2020 |
| Medicare PECOS PAC ID | 5698188159 |
|---|---|
| Medicare Enrollment ID | O20201230002768 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396331781 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Jody A Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760680797 PECOS PAC ID: 6204937584 Enrollment ID: I20070731000418 |
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