Provider Demographics
NPI:1821761230
Name:JOHNSON, ANN CATHERINE (LICSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:CATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:JOHNSON
Other - Last Name:SIREK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:2212 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55406-1425
Mailing Address - Country:US
Mailing Address - Phone:165-132-5735
Mailing Address - Fax:
Practice Address - Street 1:2212 32ND AVE S
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55406-1425
Practice Address - Country:US
Practice Address - Phone:165-132-5735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-30
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN232981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical