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Provider Information for 1083631576


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JULIE ANN JOHNSON MS, LICSW


Other Names:  
Former Name: 
JULIE ANN HABERMANN

Sex: Female

NPI: 1083631576
Last Updated: 2021-12-23
Certification Date: 2021-12-23

Details

NameValue
NPI1083631576
Enumeration Date2006-07-17
NPI TypeNPI-1 Individual
Sole ProprietorNO
StatusActive
Mailing Address PO BOX 2506
BAXTER, MN 56425-2506
United States

Phone: 218-454-0878 | Fax:218-454-0879
 
Primary Practice Address 7251 EXCELSIOR RD
BAXTER, MN 56425-8477
United States

Phone: 218-454-0878 | Fax:218-454-0879
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
MEDICAIDMN456385900
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalMN12568