Individual provider Active NPI

Annika Johnson

  • Speech-Language Pathologist
  • White Bear Lake, MN
National Provider Identifier
1235063009
Registry record updated Jun 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
CFDE-232 Issued in MN
Practice address
2555 County Road E E # 102
White Bear Lake, MN 55110-4906
Phone
(651) 683-2953
NPI assigned
Jun 9, 2026
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X CFDE-232 MN Primary

Addresses

Primary practice location

2555 County Road E E # 102
White Bear Lake, MN 55110-4906

Mailing address

8893 Griggs Ave
Circle Pines, MN 55014-3731

Other practice location 1

6776 Lake Dr Ste 220
Circle Pines, MN 55014-1192
Phone (651) 784-7007

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

Care Compare profile

Medicare Care Compare
Specialty
Qualified Speech Language Pathologist
Education
Other, 2026
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

6776 Lake Dr
Lino Lakes, MN 55014-1189

6776 Lake Dr
Suite 220
Lino Lakes, MN 55014-1192

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Advance Occupational Therapy, LLC CurrentSince Jun 1, 2026 Accepting new patients
Advance Speech Therapy, LLC Speech-Language Pathologist CurrentSince Jun 1, 2026 Accepting new patients

Locations

6776 Lake Dr
Ste 220
Lino Lakes, MN 55014
Phone (651) 784-7007

2555 County Road E E
#102
White Bear Lake, MN 55110
Phone (651) 683-2953

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1780963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780963200000",
    "number": "1235063009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8893 GRIGGS AVE",
            "city": "CIRCLE PINES",
            "state": "MN",
            "postal_code": "550143731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 COUNTY ROAD E E # 102",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551104906",
            "telephone_number": "651-683-2953"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6776 Lake Dr Ste 220",
            "address_purpose": "LOCATION",
            "city": "Circle Pines",
            "state": "MN",
            "postal_code": "550141192",
            "country_code": "US",
            "telephone_number": "651-784-7007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ANNIKA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2026-06-09",
        "last_updated": "2026-06-09",
        "certification_date": "2026-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "MN",
            "license": "CFDE-232",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in White Bear Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.