Healthcare Provider Details

I. General information

NPI: 1952080962
Provider Name (Legal Business Name): SHYANNE MARIE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 W CANAL DR STE G
KENNEWICK WA
99336-7687
US

IV. Provider business mailing address

7011 W CANAL DR STE G
KENNEWICK WA
99336-7687
US

V. Phone/Fax

Practice location:
  • Phone: 509-735-6446
  • Fax:
Mailing address:
  • Phone: 509-735-6446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: