MEDICARE: JOANNA LEE JOHNSON PSY.D.

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	103TC0700X	Clinical Psychologist	PY00003742	WA

General Provider Information

NPI Number	:	1689870826
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA LEE JOHNSON PSY.D.

Provider Business Mailing Address
First Line	:	23304 50TH AVENUE CT E
Second Line	:
City	:	SPANAWAY
State	:	WA
Zip	:	98387-6042
Country	:	US
Telephone Number	:	480-326-2093
Fax Number	:

Provider Business Practice Location Address
First Line	:	9601 STEILACOOM BLVD SW
Second Line	:
City	:	LAKEWOOD
State	:	WA
Zip	:	98498-7213
Country	:	US
Telephone Number	:	253-761-7510
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/08/2007

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