Individual
HEATHER J JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
4601 EXCELSIOR BLVD STE 411, ST LOUIS PARK, MN 55416-4977
(612) 294-9458
Mailing address
4601 EXCELSIOR BLVD STE 411, MINNEAPOLIS, MN 55416-4977
(612) 294-9458
Taxonomy
Speciality
Code
Description
License number
State
103TA0400X
Addiction (Substance Use Disorder) Psychologist
—
—
103TC1900X
Counseling Psychologist
Primary
5388
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
174658000
—
MN
Enumeration date
06/07/2010
Last updated
02/11/2019
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