Individual
KELLY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1635 43RD ST S STE 105, FARGO, ND 58103-3579
(701) 412-2973
Mailing address
1547 30TH AVE S, MOORHEAD, MN 56560-5149
(218) 287-4338
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
6079
ND
Other
Enumeration date
06/28/2021
Last updated
10/15/2025
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