Healthcare Provider Details

I. General information

NPI: 1821177718
Provider Name (Legal Business Name): JOHNNA DIETZ MS, CN, LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 NW 70TH ST
SEATTLE WA
98117-5340
US

IV. Provider business mailing address

1407 NW 70TH ST
SEATTLE WA
98117-5340
US

V. Phone/Fax

Practice location:
  • Phone: 206-227-5717
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberNU00001733
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA00020299
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: