Provider Demographics
NPI:1447529722
Name:JOHNSON, CINDY LOU
Entity type:Individual
Prefix:MISS
First Name:CINDY
Middle Name:LOU
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 ST HYW 87 NW
Mailing Address - Street 2:SCENIC FOSTER CARE
Mailing Address - City:BACKUS
Mailing Address - State:MN
Mailing Address - Zip Code:56435
Mailing Address - Country:US
Mailing Address - Phone:218-947-3989
Mailing Address - Fax:218-947-3279
Practice Address - Street 1:2123 ST HWY 87NW
Practice Address - Street 2:SCENIC FOSTER CARE
Practice Address - City:BACKUS
Practice Address - State:MN
Practice Address - Zip Code:56435
Practice Address - Country:US
Practice Address - Phone:218-947-3989
Practice Address - Fax:218-947-3279
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1061747-1-AFC172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker