Provider Demographics
NPI:1871804963
Name:JOHNSON-VISOR, SHARON (LCSW, LPC, CSAC, ICS)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:JOHNSON-VISOR
Suffix:
Gender:F
Credentials:LCSW, LPC, CSAC, ICS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6939 MARINER DR STE C
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4090
Mailing Address - Country:US
Mailing Address - Phone:262-886-8702
Mailing Address - Fax:262-886-8714
Practice Address - Street 1:6939 MARINER DR STE C
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53406-4090
Practice Address - Country:US
Practice Address - Phone:262-886-8702
Practice Address - Fax:262-886-8714
Is Sole Proprietor?:No
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1035-132101YA0400X
WI369-125101YP2500X
WI2254-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1336264829Medicaid