MEDICARE: NICOLE 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
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1942859038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE JOHNSON

Provider Business Mailing Address
First Line	:	7355 13TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-5306
Country	:	US
Telephone Number	:	262-707-8331
Fax Number	:

Provider Business Practice Location Address
First Line	:	7355 13TH AVE NW
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98117-5306
Country	:	US
Telephone Number	:	262-707-8331
Fax Number	:

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

Provider Enumeration Date	:	09/10/2019
Last Update Date	:	09/10/2019

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Directions to “ NICOLE JOHNSON ” Practice Location

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