Provider Demographics
NPI:1215445390
Name:JOHNSON, MAUREEN ELIZABETH
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-4200
Mailing Address - Country:US
Mailing Address - Phone:608-785-0001
Mailing Address - Fax:608-785-0002
Practice Address - Street 1:601 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WINONA
Practice Address - State:MN
Practice Address - Zip Code:55987-3822
Practice Address - Country:US
Practice Address - Phone:507-454-7711
Practice Address - Fax:507-452-0325
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC01554101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional