Suezan L Johnson, LCSW
Individual provider Active NPI Clinical Social Worker · North Logan, UT
NPI 1770513962 · NPPES record last updated Jan 16, 2024
Key facts
- NPI
- 1770513962
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 1264573501 (UT)
- Practice address
- 1515 N 400 E Ste 104
North Logan, UT 84341-7595 - Phone
- (435) 755-6061
- Fax
- (435) 755-6091
- NPI assigned
- Jul 3, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20060504000437 | UT | Practitioner - Clinical Social Worker | 0749290781 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126457-3501 | UT | MD | Social Worker |
| LCSW-39191 | ID | MD | Clinical Social Worker |
| 1264573501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Bear Lake Community Health Center, Inc. | Current |
Accepting new patients | |
| Bear Lake Community Health Center, Inc. | Social Worker | Current |
Accepting new patients |
| LDS Family Services | Past | Accepting new patients |
Locations
152 S 4th St
Montpelier, ID 83254
Phone (208) 847-2108
5 W 200 N
Brigham City, UT 84302
Phone (435) 723-6033
1515 N 400 E
Ste 104
North Logan, UT 84341
Phone (435) 755-8424
517 W 100 N
Ste 110
Providence, UT 84332
Phone (435) 755-6075
517 W 100 N
Ste 210
Providence, UT 84332
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 126457-3501 | UT | |
| Social Worker | 104100000X | LCSW-39191 | ID | |
| Clinical Social Worker | 1041C0700X | LCSW-39191 | ID | |
| Clinical Social Worker | 1041C0700X | 1264573501 | UT | Yes |
Addresses
Primary practice location
1515 N 400 E Ste 104
North Logan, UT 84341-7595
Mailing address
517 W 100 N Ste 210
Providence, UT 84332-9826
Phone (435) 755-6061
Other practice location 1
325 W Logan Rd
Garden City, UT 84028-7754
Phone (435) 946-3660
Other practice location 2
120 S Main St
Randolph, UT 84064-7701
Phone (435) 755-6061
Other practice location 3
517 W 100 N Ste 110
Providence, UT 84332-9826
Phone (435) 755-6075
Other practice location 4
152 S 4th St
Montpelier, ID 83254-1538
Phone (208) 847-2108
Other practice location 5
5 W 200 N
Brigham City, UT 84302-2109
Phone (435) 723-7999
Other providers in North Logan, UT
- Wesley Hyde
- Dana Marie Jackson
- Tim Leroy Jensen
- Melissa D Jex
- Karson B. Johnson
- Jon W Ahlstrom MD PC
- James Lewis Jones Jr.
- Pauline Margaret Jonsson
- Gina Gasser Jordan
- Nina G Jorgensen
All providers in North Logan, UT · Clinical Social Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.