Healthcare Provider Details

I. General information

NPI: 1154122901
Provider Name (Legal Business Name): CARLYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLYN HEIER

II. Dates (important events)

Enumeration Date: 03/19/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 140TH AVE NE
BELLEVUE WA
98005-4572
US

IV. Provider business mailing address

1313 HEADLEY AVE NW
ORTING WA
98360-9440
US

V. Phone/Fax

Practice location:
  • Phone: 425-543-7382
  • Fax:
Mailing address:
  • Phone: 253-409-9513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA.BA.70085675
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: