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General NPI Number Information
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NPI Number | 1083709679
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Entity Type | Individual
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Provider Name | KATHERINE TERESA JOHNSON M.A., L.P.
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Gender | Female
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 8897 AZTEC DRIVE
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344
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Country | US
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Telephone | 612-373-0760
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Fax |
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Provider Business Mailing Address
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Address Line | 1980 WEST 7TH STREET #220
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City | SAINT PAUL
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State | MN
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Zip | 55116-3227
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Country | US
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Telephone | 651-699-0099
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | LP2967
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License Number State | MN
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