Stacie A Johnson

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

6801070204 Issued in MI

Practice address

1108 S Van Dyke
Bad Axe, MI 48413

Phone

(989) 269-9293

Fax

(989) 269-7455

NPI assigned

Oct 18, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Central Michigan Counseling Services LLC

  • Mental Health Counselor
  • Midland, MI
  • NPI 1003542515
  Medicare reassignment NPD
• Refreshing Waters Counseling & Consulting

  • Counselor
  • Ann Arbor, MI
  • NPI 1124556386
  NPD (past)

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1306927827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8553 WILLARD ST",
            "city": "MILLINGTON",
            "state": "MI",
            "postal_code": "48746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1108 S VAN DYKE",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "48413",
            "telephone_number": "989-269-9293",
            "fax_number": "989-269-7455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "STACIE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MI",
            "license": "6801070204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Integrated Wellness Therapies LLC
• Rashid Iqbal, MD
• Jack Pine Wellness, PLLC
• Cynthia Jeffers
• Heidi Jock
• Sara Johnsonbaugh
• Elias Kabban, ATHLETIC TRAINER
• Joanna Kala, MD
• Sarah Kamyszek, CRNA
• Josette Kanaski

• Clinical Social Worker in Bad Axe, MI
• Providers in Bad Axe, MI by specialty
• Clinical Social Worker in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.