=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578095204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNIE JOHANSSON
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2017
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7363 382ND ST
-----------------------------------------------------
City | NORTH BRANCH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55056-5025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-454-0121
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7363 382ND ST
-----------------------------------------------------
City | NORTH BRANCH
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55056-5025
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 651-331-8870
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 3196
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------