Healthcare Provider Details

I. General information

NPI: 1447162441
Provider Name (Legal Business Name): JACK BLAIR JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N WARNER ST
TACOMA WA
98407-6256
US

IV. Provider business mailing address

7528 14TH AVE SW
SEATTLE WA
98106-2036
US

V. Phone/Fax

Practice location:
  • Phone: 253-302-4639
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: