Provider Demographics
NPI:1376566216
Name:JOHNSON, JOYCE ELAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ELAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 QUEENS RD SE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-9299
Mailing Address - Country:US
Mailing Address - Phone:320-762-5640
Mailing Address - Fax:320-762-5640
Practice Address - Street 1:1307 STATE HIGHWAY 29 N
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-5157
Practice Address - Country:US
Practice Address - Phone:320-808-1349
Practice Address - Fax:320-762-5640
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical