Healthcare Provider Details

I. General information

NPI: 1386720829
Provider Name (Legal Business Name): VELMA JOHNSON LMP, CM, CDP, CPE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 12/31/2020
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 BRADLEY BLVD STE 204
RICHLAND WA
99352-4500
US

IV. Provider business mailing address

3517 ROAD 84 TRLR 128B
PASCO WA
99301-1666
US

V. Phone/Fax

Practice location:
  • Phone: 509-947-9442
  • Fax:
Mailing address:
  • Phone: 509-947-9442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00000815
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCP00004233
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: