Individual
MS. KATHERINE TERESA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A., L.P.
Contact information
Practice address
8897 AZTEC DRIVE, EDEN PRAIRIE, MN 55344
(612) 373-0760
Mailing address
1980 WEST 7TH STREET, #220, SAINT PAUL, MN 55116-3227
(651) 699-0099
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2967
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7H975JO
BLUE CROSS & BLUE SHIELD
MN
Enumeration date
10/03/2006
Last updated
07/09/2007
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