MEDICARE: SEAN L JOHNSON LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SWI.LW.61420256	WA

General Provider Information

NPI Number	:	1295679066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN L JOHNSON LICSW

Provider Business Mailing Address
First Line	:	606 E THOMAS ST
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98102-5341
Country	:	US
Telephone Number	:	206-880-3708
Fax Number	:

Provider Business Practice Location Address
First Line	:	149 CHARLES ST
Second Line	:
City	:	MONROE
State	:	WA
Zip	:	98272-2302
Country	:	US
Telephone Number	:	206-880-3708
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2026
Last Update Date	:	04/14/2026

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