Provider Demographics
NPI:1902869340
Name:JOHNSON ZEMPEL, KRISTI MAE (MSW LICSW MBA)
Entity Type:Individual
Prefix:
First Name:KRISTI
Middle Name:MAE
Last Name:JOHNSON ZEMPEL
Suffix:
Gender:F
Credentials:MSW LICSW MBA
Other - Prefix:
Other - First Name:KRISTI
Other - Middle Name:MAE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23391 TAMARACK ST NW
Mailing Address - Street 2:
Mailing Address - City:SAINT FRANCIS
Mailing Address - State:MN
Mailing Address - Zip Code:55070-8621
Mailing Address - Country:US
Mailing Address - Phone:612-619-2898
Mailing Address - Fax:
Practice Address - Street 1:133 2ND AVE SW
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MN
Practice Address - Zip Code:55008-1502
Practice Address - Country:US
Practice Address - Phone:763-689-9407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN13404104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN290G5J0OtherBCBS
MN403972600Medicaid
MN1043568OtherPREFERRED ONE
136604OtherU CARE
HP48608OtherHEALTH PARTNERS
6251592OtherUBH
MN1043568OtherPREFERRED ONE