Individual provider Active NPI

Linda June Johnson, L.P.

  • Psychologist
  • Shakopee, MN
National Provider Identifier
1063638427
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP4157 Issued in MN
Practice address
500 Marschall Rd Ste 100
Shakopee, MN 55379-2689
Phone
(952) 448-6557
Fax
(952) 448-6047
NPI assigned
Apr 17, 2007
Last updated
May 15, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP4157 MN Primary

Addresses

Primary practice location

500 Marschall Rd Ste 100
Shakopee, MN 55379-2689

Mailing address

4444 W Lake Harriet Pkwy Apt 9
Minneapolis, MN 55410-1962
Phone (612) 285-7731

Other identifiers 2

IdentifierTypeStateIssuer
44177JOOtherMNBCBSM NON PAR PROVIDER #
958125100MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240229002912 MN Practitioner - Mental Health Counselor 4981055878 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
California University of Science and Medicine, 1978
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northstar RegionalGroup PAC ID 8921346669, 7 clinicians

Practice addresses (Care Compare)

1045 Stoughton Ave
Chaska, MN 55318-2149
Phone 95285639325117

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Regional CurrentSince May 19, 2024 Accepting new patients
Northstar Regional CurrentSince Feb 1, 2024 Accepting new patients
The Center for Christian Psychological Services Past Accepting new patients
Know the Truth Ministries Inc Past Accepting new patients

Locations

1045 Stoughton Ave
Chaska, MN 55318
Phone (952) 448-6557

500 Marschall Rd
Ste 100
Shakopee, MN 55379
Phone (952) 448-6557

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176768000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715731200000",
    "number": "1063638427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4444 W LAKE HARRIET PKWY APT 9",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554101962",
            "telephone_number": "612-285-7731",
            "fax_number": "651-633-5238"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 MARSCHALL RD STE 100",
            "city": "SHAKOPEE",
            "state": "MN",
            "postal_code": "553792689",
            "telephone_number": "952-448-6557",
            "fax_number": "952-448-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "LINDA",
        "middle_name": "JUNE",
        "credential": "L.P.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-17",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4157",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM NON PAR PROVIDER #",
            "identifier": "44177JO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "958125100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shakopee, MN

Sources for this page

Verify at the official NPI Registry.