Provider Demographics
NPI:1750745212
Name:JOHNSON, CAITLIN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
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 1:1462 HAZEL ST. N
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119
Mailing Address - Country:US
Mailing Address - Phone:651-491-4400
Mailing Address - Fax:
Practice Address - Street 1:2558 RICE ST.
Practice Address - Street 2:
Practice Address - City:LITTLE CANADA
Practice Address - State:MN
Practice Address - Zip Code:55113
Practice Address - Country:US
Practice Address - Phone:651-491-4400
Practice Address - Fax:651-389-0559
Is Sole Proprietor?:No
Enumeration Date:2016-04-11
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN235911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical