Healthcare Provider Details

I. General information

NPI: 1174400188
Provider Name (Legal Business Name): JOHANNAH MARIAH FREUND LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOHANNAH MARIAH SCHMIDT

II. Dates (important events)

Enumeration Date: 08/20/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 SMITH AVE N
SAINT PAUL MN
55102-2346
US

IV. Provider business mailing address

8170 33RD AVE S # MS 21110Q
BLOOMINGTON MN
55425-4516
US

V. Phone/Fax

Practice location:
  • Phone: 651-220-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number30138
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: