Individual
JORDAN LEE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MA, LPC, LPCC
Contact information
Practice address
6303 OSGOOD AVE N, STILLWATER, MN 55082-6101
(651) 383-4800
(651) 383-4801
Mailing address
6303 OSGOOD AVE N, STILLWATER, MN 55082-6101
(651) 383-4800
(651) 383-4801
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
4851-125
WI
101YP2500X
Professional Counselor
Primary
CC00629
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023346012
—
MN
05
—
1023346012
—
WI
Enumeration date
12/02/2009
Last updated
10/03/2013
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