Active NPI
Heidi J Hagen Johnson, OT
- Occupational Therapist
- Grand Forks, ND
National Provider Identifier
1861695363
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Occupational Therapist
- License
- 447
- Practice address
- 1300 S Columbia Rd
Grand Forks, ND 58201 - Phone
- (701) 780-5000
- NPI assigned
- Jun 11, 2007
- Last updated
- Mar 7, 2019
- 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 |
|---|---|---|---|---|
| Occupational Therapist | 225X00000X | 447 | ND | Primary |
Addresses
Primary practice location
1300 S Columbia Rd
Grand Forks, ND 58201
Mailing address
2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 447 | ND | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1181520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1551916800000",
"number": "1861695363",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2401 DEMERS AVE",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58201",
"telephone_number": "701-780-1891"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1300 S COLUMBIA RD",
"city": "GRAND FORKS",
"state": "ND",
"postal_code": "58201",
"telephone_number": "701-780-5000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HAGEN JOHNSON",
"first_name": "HEIDI",
"middle_name": "J",
"name_prefix": "Mrs.",
"credential": "OT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-06-11",
"last_updated": "2019-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "225X00000X",
"taxonomy_group": "",
"desc": "Occupational Therapist",
"state": "ND",
"license": "447",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Grand Forks, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.