Healthcare Provider Details

I. General information

NPI: 1245165612
Provider Name (Legal Business Name): VANESSA JO JOHNSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 1ST ST
WAUBUN MN
56589-4047
US

IV. Provider business mailing address

103 S 3RD ST W
ADA MN
56510-1519
US

V. Phone/Fax

Practice location:
  • Phone: 218-325-1531
  • Fax: 218-427-3545
Mailing address:
  • Phone: 218-325-1531
  • Fax: 218-427-3545

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: