Individual
PAMELA M JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA LP
Contact information
Practice address
516 S POKEGAMA AVE, SUITE B, GRAND RAPIDS, MN 55744-3800
(218) 327-9336
Mailing address
21206 BLUEBIRD DR, GRAND RAPIDS, MN 55744-6218
(218) 327-9336
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP3611
MN
Other
Enumeration date
10/16/2006
Last updated
07/08/2007
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