Doctor Name: | TAMMY JON FROST JOHNSON |
NPI Number: | 1184899270 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LADC |
License Number: | 302339 |
Business Practice Address: | 1405 Silver Lake Rd Nw New Brighton, MN - 551129301 |
Business Phone Number: | 6516334532 |
Business Fax Number: | 6516339311 |
Mailing Address: | 1405 Silver Lake Rd Nw, NEW BRIGHTON |
State: | MN |
Postal Code: | 551129301 |
Phone Number: | 6516334532 |
Fax Number: | 6516339311 |
NPI Enumeration Date: | 04/29/2008 |
NPI Last Update Date: | 04/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | 302339 |
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: |