Individual
KENNETH JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Contact information
Practice address
3570 LEXINGTON AVE N, SHOREVIEW, MN 55126-8049
(651) 481-0664
(651) 481-3907
Mailing address
503 LAKEWOOD DR S, MAPLEWOOD, MN 55119-5522
(651) 481-0664
(651) 481-3907
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
495
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
HP34166
HEALTH PARTNERS
MN
Enumeration date
12/14/2006
Last updated
07/08/2007
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