Healthcare Provider Details

I. General information

NPI: 1497186043
Provider Name (Legal Business Name): ANDREANNA ELISABETH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

IV. Provider business mailing address

210 W SPRAGUE AVE
SPOKANE WA
99201-3627
US

V. Phone/Fax

Practice location:
  • Phone: 509-747-8224
  • Fax: 509-747-0609
Mailing address:
  • Phone: 509-747-8224
  • Fax: 509-747-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61130270
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA60421023
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: