Individual
LACIE LEEANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
1811 WEIR DR, WOODBURY, MN 55125-2272
(651) 714-9646
Mailing address
1811 WEIR DR STE 270, WOODBURY, MN 55125-6741
(651) 379-1718
(651) 714-9647
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
17988
MN
1041C0700X
Clinical Social Worker
17988
MN
Other
Enumeration date
01/13/2010
Last updated
02/06/2018
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