Provider Demographics
NPI:1730581828
Name:JOHNSON, JENNA
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:HOFFERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3315 UNIVERSITY DR
Mailing Address - Street 2:LEWIS GOODHOUSE WELLNESS CENTER
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58504-7565
Mailing Address - Country:US
Mailing Address - Phone:701-255-3285
Mailing Address - Fax:701-530-0645
Practice Address - Street 1:3315 UNIVERSITY DR
Practice Address - Street 2:LEWIS GOODHOUSE WELLNESS CENTER
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58504-7565
Practice Address - Country:US
Practice Address - Phone:701-255-3285
Practice Address - Fax:701-530-0645
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND748-4-15-13A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health