Individual
JODY REIS-JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.DIV.,MSW, LICSW
Contact information
Practice address
3450 OLEARY LN, EAGAN, MN 55123-2340
(651) 454-0114
(651) 454-3492
Mailing address
441 JUNIPER CT, MAHTOMEDI, MN 55115-1558
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
06627
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157857000
MN CARE
MN
01
—
599K6JO
BCBS
MN
01
—
62-76634
UBH
FM
01
—
HP27073
HEALTHPARTNERS
MN
Enumeration date
10/04/2006
Last updated
07/08/2007
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