Provider Demographics
NPI:1700203973
Name:JOHNSON, DANIEL GERARD (BS LADC)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:GERARD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 6TH ST E
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55101-1654
Mailing Address - Country:US
Mailing Address - Phone:651-221-0334
Mailing Address - Fax:651-221-4449
Practice Address - Street 1:287 6TH ST E
Practice Address - Street 2:SUITE 300
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-1654
Practice Address - Country:US
Practice Address - Phone:651-221-0334
Practice Address - Fax:651-221-4449
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN303818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)