Provider Demographics
NPI:1720821770
Name:DRENTH-JOHANNSEN, KAREN KAY (LADC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:KAY
Last Name:DRENTH-JOHANNSEN
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 21ST ST SE STE 1
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-4322
Mailing Address - Country:US
Mailing Address - Phone:507-437-6389
Mailing Address - Fax:507-437-0977
Practice Address - Street 1:709 ALGON ST
Practice Address - Street 2:
Practice Address - City:ALBERT LEA
Practice Address - State:MN
Practice Address - Zip Code:56007-2069
Practice Address - Country:US
Practice Address - Phone:507-396-4477
Practice Address - Fax:507-437-0977
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN304342101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)