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General NPI Number Information
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NPI Number | 1740606227
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Entity Type | Individual
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Provider Name | JEANNE ADELAIDE JOHNSON LADC, BA, ICADC, LAC
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Gender | Female
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 8609 LYNDALE AVE S SUITE 110
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2754
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Country | US
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Telephone | 952-358-1009
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Fax | 952-881-1093
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Provider Business Mailing Address
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Address Line | 8609 LYNDALE AVE S SUITE 110
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City | BLOOMINGTON
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State | MN
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Zip | 55420-2754
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Country | US
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Telephone | 952-358-1009
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Fax | 952-881-1093
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 300969
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 9605694
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License Number State | SD
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