MEDICARE: MRS. JENNIFER SUE JOHNSON MA, LPCC

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	101YP2500X	Professional Counselor
2	101YP2500X	Professional Counselor	LPCC3552	MN

General Provider Information

NPI Number	:	1356993125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER SUE JOHNSON MA, LPCC

Provider Business Mailing Address
First Line	:	3410 FEDERAL DRIVE
Second Line	:	SUITE 101
City	:	EAGAN
State	:	MN
Zip	:	55122
Country	:	US
Telephone Number	:	651-560-0050
Fax Number	:	651-925-0257

Provider Business Practice Location Address
First Line	:	3410 FEDERAL DRIVE
Second Line	:	SUITE 101
City	:	EAGAN
State	:	MN
Zip	:	55122
Country	:	US
Telephone Number	:	651-560-0050
Fax Number	:	651-925-0257

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

Provider Enumeration Date	:	07/11/2019
Last Update Date	:	10/20/2022

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