Individual
IRIS E. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA, CCC-A
Contact information
Practice address
6341 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4946
(763) 572-5710
(763) 586-5888
Mailing address
6401 UNIVERSITY AVE NE, FRIDLEY, MN 55432-4341
(763) 572-5710
(763) 571-3008
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
5400
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
433T1JO
BCBS OF MN
MN
01
—
4500322
MEDICA
MN
01
—
HP19912
HEALTHPARTNERS
MN
Enumeration date
09/25/2006
Last updated
07/09/2007
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