Johnson, Emily Roth

Johnson, Emily Roth is an individual health care provider with primary practice located at 500 Lake Steel Street , Green Lake WI 54941. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Mental Health, Behavioral Health & Social Service Providers / Professional. Behavioral Health & Social Service Providers / Mental Health is her primary health care specialty. Johnson, Emily Roth can be contacted via phone (920) 294-4070.

Contact Information

Primary practice address
500 Lake Steel Street Green Lake WI 54941
Phone: (920) 294-4070
Fax: (920) 294-4139
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 3349125 Wisconsin
Behavioral Health & Social Service Providers / Professional 101YP2500X 3349125 Wisconsin

Profile Details

NPI number 1316077860
LBN Legal business name Johnson, Emily Roth
Credentials Licensed Professional Counselor (LPC)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 6th, 2007
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316077860 NPPES
Wisconsin MEDICAID 40994500

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