Individual
MRS. JENNIFER LYNN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
1012 BRIDGEPORT LN, ALEXANDRIA, MN 56308-8631
(218) 329-2173
Mailing address
PO BOX 164, ALEXANDRIA, MN 56308-0164
(218) 329-2173
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
1912
MN
2255A2300X
Athletic Trainer
30906
ND
Other
Enumeration date
02/14/2007
Last updated
07/11/2014
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