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NPI Code Detail

MEDICARE: JEFFREY CARL JOHNSON

MEDICARE: JEFFREY CARL JOHNSON
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
1103K00000XBehavior Analyst
2101YP2500XProfessional CounselorC4608OR

General Provider Information

NPI Number : 1609270438
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEFFREY CARL JOHNSON
Provider Business Mailing Address
First Line : PO BOX 853
Second Line :
City : ALBANY
State : OR
Zip : 97321-0569
Country : US
Telephone Number : 503-949-8959
Fax Number :
Provider Business Practice Location Address
First Line : 220 5TH AVE SW
Second Line :
City : ALBANY
State : OR
Zip : 97321-2345
Country : US
Telephone Number : 503-949-8959
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/22/2014
Last Update Date : 11/06/2023

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Directions to “ JEFFREY CARL JOHNSON ” Practice Location

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