Active NPI
Lynne Ellen Johnson, MS LP
- Psychologist
- Brainerd, MN
National Provider Identifier
1841383643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- LP2864
- Practice address
- 523 N 3Rd St
Brainerd, MN 56401-3054 - Phone
- (218) 828-7379
- Fax
- (218) 828-7390
- NPI assigned
- Oct 2, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | LP2864 | MN | Primary |
Addresses
Primary practice location
523 N 3Rd St
Brainerd, MN 56401-3054
Mailing address
4068 Green Gables Rd
Brainerd, MN 56401-7946
Phone (218) 829-6687
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)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2864 | MN | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1841383643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4068 GREEN GABLES RD",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564017946",
"telephone_number": "218-829-6687",
"fax_number": "218-829-9555"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "523 N 3RD ST",
"city": "BRAINERD",
"state": "MN",
"postal_code": "564013054",
"telephone_number": "218-828-7379",
"fax_number": "218-828-7390"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "LYNNE",
"middle_name": "ELLEN",
"name_prefix": "Ms.",
"credential": "MS LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MN",
"license": "LP2864",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brainerd, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.