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General NPI Number Information
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NPI Number | 1760295752
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Entity Type | Individual
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Provider Name | JENNIFER EILEEN JOHNSON LGSW
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Gender | Female
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Dates
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Enumeration Date | 01/31/2025
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Last Update Date | 01/31/2025
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Provider Practice Location Address
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Address Line | 3221 32ND AVE S STE 700
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City | GRAND FORKS
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State | ND
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Zip | 58201-6075
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Country | US
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Telephone | 701-335-4380
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Fax |
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Provider Business Mailing Address
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Address Line | 406 9TH ST NW
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City | FOSSTON
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State | MN
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Zip | 56542-1019
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Country | US
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Telephone | 218-308-4647
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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 | 31892
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License Number State | MN
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