MEDICARE: KAREN JOHNSON CCDC III

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	9803978	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669766366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN JOHNSON CCDC III

Provider Business Mailing Address
First Line	:	2701 S MINNESOTA AVE STE 6
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4746
Country	:	US
Telephone Number	:	605-334-1822
Fax Number	:	605-334-1823

Provider Business Practice Location Address
First Line	:	2701 S MINNESOTA AVE STE 6
Second Line	:
City	:	SIOUX FALLS
State	:	SD
Zip	:	57105-4746
Country	:	US
Telephone Number	:	605-334-1822
Fax Number	:	605-334-1823

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

Provider Enumeration Date	:	05/31/2011
Last Update Date	:	02/19/2013

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