Doctor Name: | MARILEE SUE JOHNSON |
NPI Number: | 1043555972 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MS |
License Number: | 420897A |
Business Practice Address: | 1318 W Ivy Ave Moses Lake, WA - 988372065 |
Business Phone Number: | 5097662670 |
Business Fax Number: | 5097662689 |
Mailing Address: | 920 W Ivy Ave, MOSES LAKE |
State: | WA |
Postal Code: | 988372047 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 12/04/2012 |
NPI Last Update Date: | 12/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TS0200X |
License Number: | 420897A |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | School |
Taxonomy Definition: |