Provider Demographics
NPI:1871088328
Name:CHRISTENSEN, JOHANNA ISABEL (LCSW)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:ISABEL
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:ISABEL
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11632 S WINFORD DR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-7431
Mailing Address - Country:US
Mailing Address - Phone:310-618-4330
Mailing Address - Fax:
Practice Address - Street 1:220 W 7200 S STE A
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1043
Practice Address - Country:US
Practice Address - Phone:801-566-5494
Practice Address - Fax:877-497-4661
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT860773835021041C0700X
UT8607738-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical