| Organization Name: | JAN JOHNSON |
| NPI Number: | 1093920951 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JAN J JOHNSON (DIRECTOR) |
| Mailing Address: | 201 6th St Ne Staples |
| State: | MN US |
| Postal Code: | 564792431 |
| Phone Number: | 2188940034 |
| Fax Number: | |
| NPI Enumeration Date: | 05/14/2007 |
| NPI Last Update Date: | 07/16/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 1039408-1-CDT |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MN |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |