Provider Demographics
NPI:1356993125
Name:JOHNSON, JENNIFER SUE (MA, LPCC)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:SUE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, LPCC
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:SUE
Other - Last Name:BECVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPCC
Mailing Address - Street 1:3410 FEDERAL DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122
Mailing Address - Country:US
Mailing Address - Phone:651-560-0050
Mailing Address - Fax:651-925-0257
Practice Address - Street 1:3410 FEDERAL DRIVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122
Practice Address - Country:US
Practice Address - Phone:651-560-0050
Practice Address - Fax:651-925-0257
Is Sole Proprietor?:No
Enumeration Date:2019-07-11
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
MNLPCC3552101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional