Individual
KIMBERLY ANN JOHNSON
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
MA CCCSP
Contact information
Practice address
612 S ARMSTRONG AVE, LITCHFIELD, MN 55355
(320) 693-3969
Mailing address
612 S ARMSTRONG AVE, LITCHFIELD, MN 55355
(320) 693-3969
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
7214
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
257J9J0
BLUE CROSS BLUE SHIELD
MN
Enumeration date
03/23/2006
Last updated
07/08/2007
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