Healthcare Provider Details

I. General information

NPI: 1093424566
Provider Name (Legal Business Name): LAUREN BETH JOHNSON RDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAUREN BETH ROTTMAN

II. Dates (important events)

Enumeration Date: 11/23/2022
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 LIMITED LN NW
OLYMPIA WA
98502-2704
US

IV. Provider business mailing address

PO BOX 34703
SEATTLE WA
98124-1703
US

V. Phone/Fax

Practice location:
  • Phone: 360-491-1399
  • Fax: 360-704-2914
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number61140985
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberDI61140985
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: