Allen Jerome Johnson

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

301018 Issued in MN

Practice address

14162 Commerce Ave NE
Prior Lake, MN 55372-1480

Phone

(952) 447-1117

NPI assigned

Mar 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Allen Jerome Johnson Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1394323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394323200000",
    "number": "1922424407",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "306 E 100TH ST",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554205030"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14162 COMMERCE AVE NE",
            "city": "PRIOR LAKE",
            "state": "MN",
            "postal_code": "553721480",
            "telephone_number": "952-447-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "ALLEN",
        "middle_name": "JEROME",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-03-09",
        "last_updated": "2014-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "301018",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "SD",
            "license": "99111062",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ALLEN",
            "last_name": "JOHNSON",
            "middle_name": "JEROME",
            "credential": "LADC",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Todd H Holm, M.D.
• Katherine Ann Huntington, PA
• Doreen Lubi Isubikalu
• Jolyn Rae Jaberi, D.D.S.
• Kristen Marie Jackson, MA, LPCC
• Kathryn Lynn Jonsrud, R.PH
• Charles Howard Jorenby, MA, LP
• Zachary Thomas Kahmeyer, M.A., LPCC
• Kala Counseling Services
• Stephanie Kandie, MA, LADC, LPCC

• Addiction (Substance Use Disorder) Counselor in Prior Lake, MN
• Providers in Prior Lake, MN by specialty
• Addiction (Substance Use Disorder) Counselor in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2014; 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.