Individual provider Active NPI

Janelle Johnson-Yavruian, LCSW

  • Clinical Social Worker
  • Boise, ID
National Provider Identifier
1366769515
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCSW-33075 Issued in ID
Practice address
1010 W Hays St
Boise, ID 83702-5435
Phone
(208) 600-2285
NPI assigned
Apr 28, 2010
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 11, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X LCSW-33075 ID Primary

Addresses

Primary practice location

1010 W Hays St
Boise, ID 83702-5435

Mailing address

4055 N la Mesita Way
Boise, ID 83702-1554
Phone (208) 600-2285

Other names 1

  • Janelle Johnson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
LCSW-33075IDMDClinical Social Worker

NPI Registry JSON

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

{
    "created_epoch": "1272412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1366769515",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4055 N LA MESITA WAY",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837021554",
            "telephone_number": "208-600-2285"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 W HAYS ST",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837025435",
            "telephone_number": "208-600-2285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON-YAVRUIAN",
        "first_name": "JANELLE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-04-28",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-33075",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANELLE",
            "last_name": "JOHNSON",
            "credential": "LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; 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.