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NPI Code Detail

MEDICARE: KATHRYN MARIE JOHNCOX LICSW

MEDICARE: KATHRYN MARIE JOHNCOX 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 WorkerMN
21041C0700XClinical Social Worker28604MN

General Provider Information

NPI Number : 1982376612
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN MARIE JOHNCOX LICSW
Provider Business Mailing Address
First Line : 5001 17TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55417-1211
Country : US
Telephone Number : 612-237-3331
Fax Number :
Provider Business Practice Location Address
First Line : 14665 GALAXIE AVE STE 140
Second Line :
City : APPLE VALLEY
State : MN
Zip : 55124-4509
Country : US
Telephone Number : 651-456-8494
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2021
Last Update Date : 04/22/2026

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Directions to “ KATHRYN MARIE JOHNCOX LICSW” Practice Location

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