Provider Demographics
NPI:1871801969
Name:JOHNSTON, VANESSA M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:903 SUNSHINE DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1955
Mailing Address - Country:US
Mailing Address - Phone:417-678-5361
Mailing Address - Fax:
Practice Address - Street 1:903 SUNSHINE DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1955
Practice Address - Country:US
Practice Address - Phone:417-678-5361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060054491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical