Healthcare Provider Details

I. General information

NPI: 1205748274
Provider Name (Legal Business Name): VICTORIA ROSE JOHNSON MS, LCGC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 24TH AVE S STE 400
MINNEAPOLIS MN
55454-1517
US

IV. Provider business mailing address

1410 NICOLLET AVE APT 433
MINNEAPOLIS MN
55403-2612
US

V. Phone/Fax

Practice location:
  • Phone: 612-672-6698
  • Fax:
Mailing address:
  • Phone: 224-234-2408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number1792
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: