Basic Information
| Provider Information | |||||||||
| NPI: | 1548685456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | LICSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554041025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123399101 | ||||||||
| FaxNumber: | 6127292616 | ||||||||
| Practice Location | |||||||||
| Address1: | 4123 E LAKE ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554062255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6127290340 | ||||||||
| FaxNumber: | 6127292616 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2014 | ||||||||
| LastUpdateDate: | 02/28/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 20602 | MN | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.