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NPI Code Detail

MEDICARE: MS. RENITA JOHNSON LICSW

MEDICARE: MS. RENITA 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 Worker15681MN

General Provider Information

NPI Number : 1699926170
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. RENITA JOHNSON LICSW
Provider Business Mailing Address
First Line : 980 VIRGINIA ST
Second Line :
City : SAINT PAUL
State : MN
Zip : 55117-5134
Country : US
Telephone Number : 651-270-1299
Fax Number :
Provider Business Practice Location Address
First Line : 445 MINNESOTA ST STE 1500
Second Line :
City : SAINT PAUL
State : MN
Zip : 55101-2269
Country : US
Telephone Number : 646-941-7645
Fax Number : 929-596-7897
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2008
Last Update Date : 07/17/2024

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