Provider Demographics
NPI:1992962823
Name:JOHNSON, T LEANNE (MSSW)
Entity type:Individual
Prefix:MRS
First Name:T
Middle Name:LEANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5201 BISHOPS BLVD S
Mailing Address - Street 2:SUITE B
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-7608
Mailing Address - Country:US
Mailing Address - Phone:701-235-4457
Mailing Address - Fax:701-356-7993
Practice Address - Street 1:5201 BISHOPS BLVD S
Practice Address - Street 2:SUITE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-7608
Practice Address - Country:US
Practice Address - Phone:701-235-4457
Practice Address - Fax:701-356-7993
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3195104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker