MEDICARE: LAUREL JOHNSON CSWA

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	A16501	OR

General Provider Information

NPI Number	:	1588992028
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREL JOHNSON CSWA

Provider Business Mailing Address
First Line	:	2154 NE BROADWAY ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1561
Country	:	US
Telephone Number	:	503-473-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	2154 NE BROADWAY ST STE 110
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1561
Country	:	US
Telephone Number	:	503-473-2081
Fax Number	:

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

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	01/13/2026

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Directions to “ LAUREL JOHNSON CSWA” Practice Location

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