Individual
MS. MARCIE C JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MSW, LICSW
Contact information
Practice address
2265 COMO AVE, SUITE 201, SAINT PAUL, MN 55108-1737
(651) 646-8985
(651) 646-3959
Mailing address
2265 COMO AVE, SUITE 201, SAINT PAUL, MN 55108-1737
(651) 646-8985
(651) 646-3959
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
07546
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01012588
PREFERRED ONE
—
01
—
42G11JO
BLUE CROSS/BLUE SHIELD
—
Enumeration date
08/13/2006
Last updated
07/08/2007
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