Healthcare Provider Details

I. General information

NPI: 1730002148
Provider Name (Legal Business Name): OKSANA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W BROAD AVE
FLANDREAU SD
57028-1630
US

IV. Provider business mailing address

1424 7TH ST
BROOKINGS SD
57006-1638
US

V. Phone/Fax

Practice location:
  • Phone: 515-782-2441
  • Fax:
Mailing address:
  • Phone: 515-782-2441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30944
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: