Provider Demographics
NPI:1376683474
Name:JOHNSON, JANET (MSCCCSLP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 PILOT KNOB RD
Mailing Address - Street 2:STE 100
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-1930
Mailing Address - Country:US
Mailing Address - Phone:651-994-9644
Mailing Address - Fax:651-994-8962
Practice Address - Street 1:14635 PENNOCK AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:APPLE VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55124-6430
Practice Address - Country:US
Practice Address - Phone:952-997-2823
Practice Address - Fax:952-997-6931
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5593235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN96453JOOtherBCBS
MNHP42421OtherHEALTH PARTNERS
MN060910200Medicaid
MN4600649OtherMEDICA