Provider Demographics
NPI:1477900140
Name:JOHNSON, CARRIE L (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1939
Mailing Address - Country:US
Mailing Address - Phone:612-752-8216
Mailing Address - Fax:612-752-8201
Practice Address - Street 1:1825 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1939
Practice Address - Country:US
Practice Address - Phone:612-752-8216
Practice Address - Fax:612-752-8201
Is Sole Proprietor?:No
Enumeration Date:2016-05-23
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN226671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical