Individual provider Active NPI

Jean Elizabeth Johnson, PSYD

  • Intellectual & Developmental Disabilities Psychologist
  • Eagan, MN
National Provider Identifier
1285837948
Registry record updated Sep 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X
License
LP4356 Issued in MN
Practice address
1301 Corporate Center Dr
Suite 116
Eagan, MN 55121-1298
Phone
(651) 905-1814
Fax
(651) 905-1815
NPI assigned
Jun 8, 2007
Last updated
Sep 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 11, 2025

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

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LP4356 MN
Psychologist 103T00000X LP4356 MN
Adult Development & Aging Psychologist 103TA0700X LP4356 MN
Cognitive & Behavioral Psychologist 103TB0200X LP4356 MN
Clinical Psychologist 103TC0700X LP4356 MN
Clinical Child & Adolescent Psychologist 103TC2200X LP4356 MN
Family Psychologist 103TF0000X LP4356 MN
Intellectual & Developmental Disabilities Psychologist 103TM1800X LP4356 MN Primary

Addresses

Primary practice location

1301 Corporate Center Dr
Suite 116
Eagan, MN 55121-1298

Mailing address

8362 Tamarack VLG
Suite 119, Box 172
Woodbury, MN 55125-3392
Phone (651) 402-6209

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP4356MNMDPsychologist

Organizations & group practices 1

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": "1181260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1285837948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8362 TAMARACK VLG",
            "address_2": "SUITE 119, BOX 172",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551253392",
            "telephone_number": "651-402-6209",
            "fax_number": "651-905-1815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 CORPORATE CENTER DR",
            "address_2": "SUITE 116",
            "city": "EAGAN",
            "state": "MN",
            "postal_code": "551211298",
            "telephone_number": "651-905-1814",
            "fax_number": "651-905-1815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEAN",
        "middle_name": "ELIZABETH",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-06-08",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "MN",
            "license": "LP4356",
            "primary": false
        },
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "MN",
            "license": "LP4356",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Eagan, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.