Provider Demographics
NPI:1477784981
Name:JOHNSON, WINDY (LSW)
Entity Type:Individual
Prefix:
First Name:WINDY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 JACKSON ST NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1672
Mailing Address - Country:US
Mailing Address - Phone:612-236-1718
Mailing Address - Fax:612-236-1701
Practice Address - Street 1:1121 JACKSON ST NE
Practice Address - Street 2:SUITE 105
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1672
Practice Address - Country:US
Practice Address - Phone:612-236-1718
Practice Address - Fax:612-236-1701
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-31
Last Update Date:2009-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN14462104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker