Provider Demographics
NPI:1346713377
Name:JOHNSON, MOLLY PATRICIA (LICSW, LADC)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:PATRICIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32298 STATE HIGHWAY 13
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:MN
Mailing Address - Zip Code:56069-4348
Mailing Address - Country:US
Mailing Address - Phone:507-364-5312
Mailing Address - Fax:507-364-5908
Practice Address - Street 1:1031 GRACE ST
Practice Address - Street 2:
Practice Address - City:SAINT PETER
Practice Address - State:MN
Practice Address - Zip Code:56082-1300
Practice Address - Country:US
Practice Address - Phone:507-364-5312
Practice Address - Fax:507-364-5908
Is Sole Proprietor?:No
Enumeration Date:2019-01-02
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303474101YA0400X
MN283581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)