Provider Demographics
NPI:1609173475
Name:JOHANNECK, VICTORIA JEAN (PSYD, MDIV)
Entity Type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:JEAN
Last Name:JOHANNECK
Suffix:
Gender:F
Credentials:PSYD, MDIV
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:JEAN
Other - Last Name:BENTSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1727 PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:MN
Mailing Address - Zip Code:55313-2231
Mailing Address - Country:US
Mailing Address - Phone:612-245-7104
Mailing Address - Fax:
Practice Address - Street 1:2501 HANLEY RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:WI
Practice Address - Zip Code:54016-8705
Practice Address - Country:US
Practice Address - Phone:715-381-1980
Practice Address - Fax:715-381-1906
Is Sole Proprietor?:No
Enumeration Date:2011-02-14
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional