Individual
NICOLE ELISE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
500 HARVARD ST SE, MINNEAPOLIS, MN 55455-0363
(612) 273-8383
Mailing address
401 1ST AVE NE UNIT 527, MINNEAPOLIS, MN 55413-3155
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
10407
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10407
MINNESOTA DEPARTMENT OF HEALTH
MN
Enumeration date
06/30/2021
Last updated
06/30/2021
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