| Maddie Johnson, Llc | |
|
11292 86th Ave N # 10655369 Maple Grove MN 55369-4510 | |
| (507) 774-0731 | |
| Not Available |
| Full Name | Maddie Johnson, Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 11292 86th Ave N # 10655369, Maple Grove, Minnesota |
| Authorized Official Name and Position | Madeline Johnson (CEO) |
| Authorized Official Contact | 8475258852 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Maddie Johnson, Llc 3659 Main St Ne Minneapolis MN 55418-1133 Ph: (847) 525-8852 | Maddie Johnson, Llc 11292 86th Ave N # 10655369 Maple Grove MN 55369-4510 Ph: (507) 774-0731 |
| NPI Number | 1770236812 |
|---|---|
| Provider Enumeration Date | 01/29/2022 |
| Last Update Date | 01/29/2022 |
| Certification Date | 01/29/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770236812 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
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