Provider Demographics
NPI:1659241479
Name:JOHANSEN, SYDNEY LYNN
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:LYNN
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:924 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56001-3320
Mailing Address - Country:US
Mailing Address - Phone:507-828-9001
Mailing Address - Fax:
Practice Address - Street 1:816 S FRONT ST
Practice Address - Street 2:
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001-2401
Practice Address - Country:US
Practice Address - Phone:507-828-9001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-06
Last Update Date:2025-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional