MEDICARE: MS. STEPHANIE DIANE JOHNSON LGSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	9768	MN

General Provider Information

NPI Number	:	1356298558
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE DIANE JOHNSON LGSW

Provider Business Mailing Address
First Line	:	12310 SINGLETREE LN APT 2210
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7985
Country	:	US
Telephone Number	:	612-558-2999
Fax Number	:

Provider Business Practice Location Address
First Line	:	12310 SINGLETREE LN APT 2210
Second Line	:
City	:	EDEN PRAIRIE
State	:	MN
Zip	:	55344-7985
Country	:	US
Telephone Number	:	612-558-2999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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