Provider Demographics
NPI:1881560092
Name:JOHNSON, SHANNON (LMFT-IT, MSED)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMFT-IT, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233A BUSINESS PARK DR STE 302
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54482-8861
Mailing Address - Country:US
Mailing Address - Phone:800-681-2374
Mailing Address - Fax:
Practice Address - Street 1:3233A BUSINESS PARK DR STE 302
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-8861
Practice Address - Country:US
Practice Address - Phone:800-681-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1195-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist