Mary Elizabeth Johnson, LCSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

8911068 Issued in ID

Practice address

1329 Ammon Park Dr
Ammon, ID 83406-4591

Phone

(208) 403-0135

NPI assigned

Jun 6, 2022

Last updated

Jan 21, 2025By 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 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": "1654473600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737417600000",
    "number": "1679202758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30131 BULVERDE LN UNIT 371",
            "city": "BULVERDE",
            "state": "TX",
            "postal_code": "781638821",
            "telephone_number": "602-300-7302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1329 AMMON PARK DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064591",
            "telephone_number": "208-403-0135"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "18756 Stone Oak Pkwy",
            "address_2": "Suite 200, Office #231",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "78258",
            "country_code": "US",
            "telephone_number": "830-513-5775",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "MARY",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-06",
        "last_updated": "2025-01-21",
        "certification_date": "2025-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "TX",
            "license": "65860",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "8911068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rebecca Jensen, CBRS/CM
• Tarren Nicole Johnsen
• Connor Johnson, DPT
• Erin Lee Johnson, AU.D.
• Ike Johnson, BS
• Morgan Johnson, BS
• Neccia Johnson, INTERN
• Sonja Johnson, LPC
• Heidi Jones, BS
• Alicia Jorgensen, FNP-C

• Social Worker in Ammon, ID
• Providers in Ammon, ID by specialty
• Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 21, 2025; 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.