Provider Demographics
NPI:1497637730
Name:JOHNSON, ROSE (LPCC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:BAYPORT
Mailing Address - State:MN
Mailing Address - Zip Code:55003-1110
Mailing Address - Country:US
Mailing Address - Phone:612-840-4701
Mailing Address - Fax:
Practice Address - Street 1:10150 CITY WALK DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55129-9257
Practice Address - Country:US
Practice Address - Phone:651-376-3388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-25
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC04648101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health