Healthcare Provider Details

I. General information

NPI: 1629905260
Provider Name (Legal Business Name): BRIAN JAMES JOHNSOSN MSW/LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 3RD AVE NE
BUFFALO MN
55313-1925
US

IV. Provider business mailing address

1405 3RD AVE NE
BUFFALO MN
55313-1925
US

V. Phone/Fax

Practice location:
  • Phone: 763-682-6440
  • Fax:
Mailing address:
  • Phone: 763-682-6440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15796
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: