Individual
DR. NICOLE MARIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
200 E TRAVELERS TRL STE 205, BURNSVILLE, MN 55337-4191
(612) 249-0269
Mailing address
200 E TRAVELERS TRL STE 205, BURNSVILLE, MN 55337-4191
(612) 249-0269
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP6452
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750868212
NPI I
MN
Enumeration date
07/26/2018
Last updated
09/11/2020
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