Individual
BROOKE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
69 EXCHANGE ST W, SAINT PAUL, MN 55102-1004
(651) 232-4284
(651) 326-3900
Mailing address
5226 LAKEVIEW AVE, WHITE BEAR LAKE, MN 55110-7811
(952) 484-7100
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
304552
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-0898277
—
MN
Enumeration date
04/04/2017
Last updated
04/28/2017
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