Provider Demographics
NPI:1063510444
Name:JOHNSON, ROBYN MARIE (PSYD, LP)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12100 SINGLETREE LN
Mailing Address - Street 2:SUITE 142
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55344-7919
Mailing Address - Country:US
Mailing Address - Phone:612-747-6139
Mailing Address - Fax:952-746-1201
Practice Address - Street 1:12100 SINGLETREE LN
Practice Address - Street 2:SUITE 142
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-7919
Practice Address - Country:US
Practice Address - Phone:612-747-6139
Practice Address - Fax:952-746-1201
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4393103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist