Provider Demographics
NPI:1790008134
Name:JOHNSON, WILLIAM ERIC
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ERIC
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9875 101ST ST NE
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MN
Mailing Address - Zip Code:55362-1904
Mailing Address - Country:US
Mailing Address - Phone:612-968-2918
Mailing Address - Fax:
Practice Address - Street 1:1125 CEDAR ST STE 117
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:MN
Practice Address - Zip Code:55362-4411
Practice Address - Country:US
Practice Address - Phone:612-968-2918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN00266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional