Provider Demographics
NPI:1992806442
Name:DEANE JOHNSON, KAREN E (LICSW)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:DEANE JOHNSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 CARVER SQ
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-9686
Mailing Address - Country:US
Mailing Address - Phone:952-442-1289
Mailing Address - Fax:
Practice Address - Street 1:480 W 78TH ST
Practice Address - Street 2:SUITE 101A
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-4527
Practice Address - Country:US
Practice Address - Phone:952-212-0518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN233104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker