Individual
IVY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
408 SAINT PETER ST STE 429, SAINT PAUL, MN 55102-1119
(651) 224-0614
(651) 224-5754
Mailing address
408 SAINT PETER ST STE 429, SAINT PAUL, MN 55102-1119
(651) 224-0614
(651) 224-5754
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
28148
MN
Other
Enumeration date
01/20/2022
Last updated
01/20/2022
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