Healthcare Provider Details

I. General information

NPI: 1649663790
Provider Name (Legal Business Name): ASHLEY JOHSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2045 NE LINNEA DR APT 305
BEND OR
97701-7444
US

IV. Provider business mailing address

2045 NE LINNEA DR APT 305
BEND OR
97701-7444
US

V. Phone/Fax

Practice location:
  • Phone: 253-948-6913
  • Fax:
Mailing address:
  • Phone: 253-948-6913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierCG 60506476
Identifier TypeOTHER
Identifier StateWA
Identifier IssuerWASHINGTON STATE DEP. OF HEALTH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: