Suezan L Johnson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1264573501 Issued in 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

Last updated

Jan 16, 2024By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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.

• Bear Lake Community Health Center, Inc.

  dba Bear Lake Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Garden City, UT
  • NPI 1689754475
  Medicare reassignment NPD
• Bear Lake Community Health Center, Inc.

  dba Bear Lake Community Health Center

  • Family Medicine Physician
  • Garden City, UT
  • NPI 1629309786

  Social Worker

  NPD
• LDS Family Services

  dba LDS Family Services UT Logan Agency

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Logan, UT
  • NPI 1801994132
  NPD (past)

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

{
    "created_epoch": "1151884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705363200000",
    "number": "1770513962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 W 100 N STE 210",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329826",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-8362"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 N 400 E STE 104",
            "city": "NORTH LOGAN",
            "state": "UT",
            "postal_code": "843417595",
            "telephone_number": "435-755-6061",
            "fax_number": "435-755-6091"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "152 S 4th St",
            "address_purpose": "LOCATION",
            "city": "Montpelier",
            "state": "ID",
            "postal_code": "832541538",
            "country_code": "US",
            "telephone_number": "208-847-2108",
            "fax_number": "208-847-2109",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5 W 200 N",
            "address_purpose": "LOCATION",
            "city": "Brigham City",
            "state": "UT",
            "postal_code": "843022109",
            "country_code": "US",
            "telephone_number": "435-723-7999",
            "fax_number": "435-723-7331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "120 S Main St",
            "address_purpose": "LOCATION",
            "city": "Randolph",
            "state": "UT",
            "postal_code": "840647701",
            "country_code": "US",
            "telephone_number": "435-755-6061",
            "fax_number": "435-994-3806",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "517 W 100 N Ste 110",
            "address_purpose": "LOCATION",
            "city": "Providence",
            "state": "UT",
            "postal_code": "843329826",
            "country_code": "US",
            "telephone_number": "435-755-6075",
            "fax_number": "435-723-7331",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "325 W Logan Rd",
            "address_purpose": "LOCATION",
            "city": "Garden City",
            "state": "UT",
            "postal_code": "840287754",
            "country_code": "US",
            "telephone_number": "435-946-3660",
            "fax_number": "435-946-8215",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SUEZAN",
        "middle_name": "L",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-03",
        "last_updated": "2024-01-16",
        "certification_date": "2024-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "UT",
            "license": "126457-3501",
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "ID",
            "license": "LCSW-39191",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "LCSW-39191",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "1264573501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Wesley Hyde
• Dana Marie Jackson, LCSW
• Tim Leroy Jensen, MOTR/L
• Melissa D Jex
• Karson B. Johnson, D.C.
• Jon W Ahlstrom MD PC
• James Lewis Jones Jr., ACNP
• Pauline Margaret Jonsson, OTR/L
• Gina Gasser Jordan, FNP
• Nina G Jorgensen, M.D.

• Clinical Social Worker in North Logan, UT
• Providers in North Logan, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2024; 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.