=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437650553
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALISON JOHNSON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2018
-----------------------------------------------------
Last Update Date | 02/13/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11303 S MULINO RD
-----------------------------------------------------
City | CANBY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-404-5577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11303 S MULINO RD
-----------------------------------------------------
City | CANBY
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97013-6727
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 541-404-5577
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | ALISON MICHELE JOHNSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 541-404-5577
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | L6304
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------