Provider Demographics
NPI:1700945995
Name:JOHNSON, KARIN MARIE (MA)
Entity type:Individual
Prefix:MS
First Name:KARIN
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13350 195TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ATWATER
Mailing Address - State:MN
Mailing Address - Zip Code:56209
Mailing Address - Country:US
Mailing Address - Phone:320-235-4613
Mailing Address - Fax:320-231-9140
Practice Address - Street 1:WOODLAND CENTERS
Practice Address - Street 2:1125 6TH STREET SE
Practice Address - City:WILLMAR
Practice Address - State:MN
Practice Address - Zip Code:56201-4675
Practice Address - Country:US
Practice Address - Phone:320-231-9148
Practice Address - Fax:320-231-9140
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3149103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1013095OtherPREFERRED ONE
115373OtherUCARE
6233168OtherUBH
7H095JOOtherBLUE CROSS