Healthcare Provider Details

I. General information

NPI: 1922179068
Provider Name (Legal Business Name): MRS. KARI JOHANNSEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 08/11/2024
Certification Date: 08/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2863 NW CROSSING DR STE 212
BEND OR
97703-7190
US

IV. Provider business mailing address

1866 NW IOWA AVE
BEND OR
97703-1010
US

V. Phone/Fax

Practice location:
  • Phone: 541-301-6591
  • Fax:
Mailing address:
  • Phone: 541-301-6591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL11622
License Number StateOR

VII. Legacy identifiers

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: