Individual
JACLYN RACHEL JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, LPCC, LADC
Contact information
Practice address
4100 BERKSHIRE LN N, PLYMOUTH, MN 55446-3813
(763) 203-9568
Mailing address
4100 BERKSHIRE LN N, PLYMOUTH, MN 55446-3813
(763) 203-9568
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
306063
MN
101YP2500X
Professional Counselor
Primary
CC04220
MN
Other
Enumeration date
10/08/2021
Last updated
02/01/2024
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