Individual
MS. ELAINE K JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LP, LADC
Contact information
Practice address
6607 18TH AVE S, SUITE 101, RICHFIELD, MN 55423-2784
(612) 798-7373
(612) 243-3615
Mailing address
6607 18TH AVE S, SUITE 101, RICHFIELD, MN 55423-2784
(612) 798-7373
(612) 243-3615
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
67372700
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67372700
MN HEALTHCARE PROGRAM NO.
MN
Enumeration date
02/21/2007
Last updated
07/08/2007
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