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General NPI Number Information
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NPI Number | 1639940711
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Entity Type | Individual
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Provider Name | DEBRA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 4257 SW 42ND ST
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City | REDMOND
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State | OR
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Zip | 97756-6977
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Country | US
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Telephone | 541-224-8837
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 EXECUTIVE PKWY STE 260
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City | EUGENE
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State | OR
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Zip | 97401-7121
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Country | US
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Telephone | 541-224-8837
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3606
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 103TF0200X
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Taxonomy Name | Forensic Psychologist
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License Number |
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License Number State |
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