Provider Demographics
NPI:1588717466
Name:JOHNSON, JULIE ANN (BSW)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:JULIE
Other - Middle Name:ANN
Other - Last Name:ANDRESEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:120 NORTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:PARK RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:56420
Mailing Address - Country:US
Mailing Address - Phone:218-732-7266
Mailing Address - Fax:218-732-0136
Practice Address - Street 1:120 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:PARK RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:56420
Practice Address - Country:US
Practice Address - Phone:218-732-7266
Practice Address - Fax:218-732-0136
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner