Healthcare Provider Details

I. General information

NPI: 1477784981
Provider Name (Legal Business Name): WINDY JOHNSON LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2009
Last Update Date: 07/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 JACKSON ST NE SUITE 105
MINNEAPOLIS MN
55413-1672
US

IV. Provider business mailing address

1121 JACKSON ST NE SUITE 105
MINNEAPOLIS MN
55413-1672
US

V. Phone/Fax

Practice location:
  • Phone: 612-236-1718
  • Fax: 612-236-1701
Mailing address:
  • Phone: 612-236-1718
  • Fax: 612-236-1701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number14462
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: