Provider Demographics
NPI:1083631576
Name:JOHNSON, JULIE ANN (MS, LICSW)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LICSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:HABERMANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2506
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:MN
Mailing Address - Zip Code:56425-2506
Mailing Address - Country:US
Mailing Address - Phone:218-454-0878
Mailing Address - Fax:218-454-0879
Practice Address - Street 1:7251 EXCELSIOR RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:MN
Practice Address - Zip Code:56425-8477
Practice Address - Country:US
Practice Address - Phone:218-454-0878
Practice Address - Fax:218-454-0879
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN125681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN456385900Medicaid