Provider Demographics
NPI:1912372632
Name:JOHNSON, KATIE LYN JENSEN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN JENSEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYN
Other - Last Name:JENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:9400 ZANE AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55443-1814
Mailing Address - Country:US
Mailing Address - Phone:763-762-8813
Mailing Address - Fax:763-315-3539
Practice Address - Street 1:9400 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1814
Practice Address - Country:US
Practice Address - Phone:763-762-8813
Practice Address - Fax:763-315-3539
Is Sole Proprietor?:No
Enumeration Date:2015-12-07
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist