MEDICARE: MEGAN JOHNSON LGSW

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
1	104100000X	Social Worker

General Provider Information

NPI Number	:	1568151314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN JOHNSON LGSW

Provider Business Mailing Address
First Line	:	4225 DESOTO STREET
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55127-7944
Country	:	US
Telephone Number	:	269-823-8797
Fax Number	:

Provider Business Practice Location Address
First Line	:	4225 DESOTO STREET
Second Line	:
City	:	VADNAIS HEIGHTS
State	:	MN
Zip	:	55127-7944
Country	:	US
Telephone Number	:	269-823-8797
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/05/2023
Last Update Date	:	05/05/2023

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