Itina V Johnson, SAC-IT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

19618-130 Issued in WI

Practice address

1409 Emil St Ste 100
Madison, WI 53713-2311

Phone

(608) 283-6426

Fax

(608) 283-6374

NPI assigned

Jul 21, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1595289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1647216000000",
    "number": "1255949723",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "151 E BADGER RD",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132725",
            "telephone_number": "608-250-2512"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 EMIL ST STE 100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537132311",
            "telephone_number": "608-283-6426",
            "fax_number": "608-283-6374"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ITINA",
        "middle_name": "V",
        "credential": "SAC-IT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-21",
        "last_updated": "2022-03-14",
        "certification_date": "2022-03-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19618-130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary Lee Johnson, MD
• Grace Ann Johnson
• Greta Eileen Johnson, LPC-IT
• Hadley Johnson, MD
• Hillary Ray Johnson, MD
• Jake Michael Johnson, PHARMD
• Jennifer Johnson, PHARM D
• Jessica Johnson, PT
• Jessica Lamarr Johnson, MD
• Joel O Johnson, MD

• Addiction (Substance Use Disorder) Counselor in Madison, WI
• Providers in Madison, WI by specialty
• Addiction (Substance Use Disorder) Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.