Jeanie Johnson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

30365 Issued in MN

Practice address

1902 Valley Pine Cir
International Falls, MN 56649-2179

Phone

(218) 283-3406

NPI assigned

Jul 11, 2024

Last updated

Jul 11, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Northland Counseling Center IncGroup PAC ID 1153389242, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Northland Counseling Center, Inc.

  • Community/Behavioral Health Agency
  • Grand Rapids, MN
  • NPI 1164610986

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Northland Counseling Center Kooch Office

  • Community/Behavioral Health Agency
  • International Falls, MN
  • NPI 1720266794

  Single Specialty

  NPD

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

{
    "created_epoch": "1720656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1639916265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 VALLEY PINE CIR",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492179",
            "telephone_number": "218-283-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 VALLEY PINE CIR",
            "city": "INTERNATIONAL FALLS",
            "state": "MN",
            "postal_code": "566492179",
            "telephone_number": "218-283-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JEANIE",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MN",
            "license": "30365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• International Falls Memorial Hospital
• International Falls Memorial Hospital Association (Rainy Lake Medical Center)
• International Falls Memorial Hospital Association (Rainy Lake Pharmacy)
• International Falls Memorial Hospital Association (Rainy Lake Medical Center)
• Douglas Allan Johnson
• Willard Johnson, PHD, LP
• Linda Kawulia, RPH.
• Heather Nichole Klemetsen, MS, LADC, LPCC
• Jay B Knaak, M.D.
• Nancy Lynn Knaak, APRN-CNP

• Clinical Social Worker in International Falls, MN
• Providers in International Falls, MN by specialty
• Clinical Social Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.