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General NPI Number Information
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NPI Number | 1699926170
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Entity Type | Individual
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Provider Name | RENITA JOHNSON LICSW
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Gender | Female
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 07/17/2024
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Provider Practice Location Address
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Address Line | 445 MINNESOTA ST STE 1500
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City | SAINT PAUL
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State | MN
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Zip | 55101-2269
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Country | US
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Telephone | 646-941-7645
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Fax | 929-596-7897
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Provider Business Mailing Address
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Address Line | 980 VIRGINIA ST
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City | SAINT PAUL
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State | MN
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Zip | 55117-5134
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Country | US
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Telephone | 651-270-1299
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15681
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License Number State | MN
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