Provider Demographics
NPI:1700420114
Name:JOHNSON, ANNE CHRISTINE (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:CHRISTINE
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 1:6625 LYNDALE AVE S STE 440
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:MN
Mailing Address - Zip Code:55423-2380
Mailing Address - Country:US
Mailing Address - Phone:126-968-2508
Mailing Address - Fax:
Practice Address - Street 1:6625 LYNDALE AVE S STE 440
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:MN
Practice Address - Zip Code:55423-2380
Practice Address - Country:US
Practice Address - Phone:126-712-7200
Practice Address - Fax:126-677-3123
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN255641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical