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Individual

MRS. IRENE TERESA JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MSW, LCSW, LICSW

Contact information

Practice address
2102 ELM STREET N FARGO VA HCS, FARGO, ND 58102
(701) 239-3700
(307) 745-8761
Mailing address
2101 ELM STREET N FARGO VA HCS, FARGO, ND 58102
(307) 745-8915

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
27855
MN
1041C0700X
Clinical Social Worker
374
WY
1041C0700X
Clinical Social Worker
LCSW-374
WY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
311123
BS
WY
01
800012487
RR MED
Enumeration date
07/12/2005
Last updated
04/10/2025
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