Healthcare Provider Details

I. General information

NPI: 1215846761
Provider Name (Legal Business Name): HJALMAR CARL JOHNSON III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11909 N DIVISION ST STE 102
SPOKANE WA
99218-1969
US

IV. Provider business mailing address

2618 W KIERNAN AVE
SPOKANE WA
99205-2346
US

V. Phone/Fax

Practice location:
  • Phone: 509-213-1442
  • Fax:
Mailing address:
  • Phone: 425-275-1822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: