Provider Demographics
NPI:1861531998
Name:JOHNSON, RORI JOANNA (PSYD LP)
Entity type:Individual
Prefix:
First Name:RORI
Middle Name:JOANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5842 OLD MAIN ST STE 2
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MN
Mailing Address - Zip Code:55056-6698
Mailing Address - Country:US
Mailing Address - Phone:651-401-3061
Mailing Address - Fax:651-674-2534
Practice Address - Street 1:5842 OLD MAIN ST STE 2
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MN
Practice Address - Zip Code:55056-6698
Practice Address - Country:US
Practice Address - Phone:651-401-3061
Practice Address - Fax:651-674-2534
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist