Provider Demographics
NPI:1194707869
Name:JOHNSON, LYNDALL (MA LP)
Entity type:Individual
Prefix:MS
First Name:LYNDALL
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 ERIN DR
Mailing Address - Street 2:#260
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-3398
Mailing Address - Country:US
Mailing Address - Phone:651-686-8818
Mailing Address - Fax:
Practice Address - Street 1:4555 ERIN DR
Practice Address - Street 2:#260
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3398
Practice Address - Country:US
Practice Address - Phone:651-686-8818
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP 1001103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist