| Robert E. Johnson, Licensed Psychologist | |
|
2579 Hamline Ave N Suite D Roseville MN 55113-3186 | |
| (651) 628-0947 | |
| (651) 636-2922 |
| Full Name | Robert E. Johnson, Licensed Psychologist |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 2579 Hamline Ave N, Roseville, Minnesota |
| Authorized Official Name and Position | Robert Edward Johnson (LICENSED PSYCHOLOGIST) |
| Authorized Official Contact | 6516280947 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Robert E. Johnson, Licensed Psychologist 2579 Hamline Ave N Suite D Roseville MN 55113-3186 Ph: (651) 628-0947 | Robert E. Johnson, Licensed Psychologist 2579 Hamline Ave N Suite D Roseville MN 55113-3186 Ph: (651) 628-0947 |
| NPI Number | 1235304981 |
|---|---|
| Provider Enumeration Date | 04/24/2008 |
| Last Update Date | 04/24/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235304981 | NPI | - | NPPES |
| 099347600 | Medicaid | MN | |
| 1225134687 | Other | MN | INDIVIDUAL NPI ALREADY ISSUED MEDICARE INFORMED US NEEDED GROUP ALSO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | LP1796 (Minnesota) | Primary |
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