Provider Demographics
NPI:1568109908
Name:JOHNSON, ROBERTA JO (LAPC)
Entity Type:Individual
Prefix:MRS
First Name:ROBERTA
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAPC
Other - Prefix:
Other - First Name:BOBBIE
Other - Middle Name:JO
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAPC
Mailing Address - Street 1:1679 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-2904
Mailing Address - Country:US
Mailing Address - Phone:701-483-1000
Mailing Address - Fax:701-483-1001
Practice Address - Street 1:1679 6TH AVE W
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-2904
Practice Address - Country:US
Practice Address - Phone:701-483-1000
Practice Address - Fax:701-483-1001
Is Sole Proprietor?:No
Enumeration Date:2022-05-17
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1195-5-15-22A101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional