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NPI Code Detail

MEDICARE: MS. JOANNA LYNN JOHNSON LICSW

MEDICARE: MS. JOANNA LYNN JOHNSON LICSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker15968MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
115968OTHERMNCOMMERCIAL INSURANCES
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1255982211
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JOANNA LYNN JOHNSON LICSW
Provider Business Mailing Address
First Line : 4826 CHICAGO AVE STE 105
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1055
Country : US
Telephone Number : 612-827-3028
Fax Number :
Provider Business Practice Location Address
First Line : 4826 CHICAGO AVE STE 105
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1055
Country : US
Telephone Number : 612-827-3028
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2019
Last Update Date : 07/03/2020

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