Provider Demographics
NPI:1366410102
Name:JOHNSTON, LAURA D (LISW)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LOWERY LN
Mailing Address - Street 2:
Mailing Address - City:NEW CONCORD
Mailing Address - State:OH
Mailing Address - Zip Code:43762-9795
Mailing Address - Country:US
Mailing Address - Phone:740-826-4376
Mailing Address - Fax:
Practice Address - Street 1:2500 JOHN GLENN HWY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9028
Practice Address - Country:US
Practice Address - Phone:740-454-9766
Practice Address - Fax:740-588-6452
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI85731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000340445OtherANTHEM PIN
OH352005OtherTRICARE/MHN PIN
OH7372590OtherAETNA PIN
OHY08573OtherTHE HEALTH PLAN PIN
OHY08573OtherTHE HEALTH PLAN PIN