Provider Demographics
NPI:1013400688
Name:JOHNSON, AMANDA LEE (BSW)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1193 NW MONTERY CT
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8630
Mailing Address - Country:US
Mailing Address - Phone:803-636-7506
Mailing Address - Fax:
Practice Address - Street 1:2625 WHEATON WAY
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310-3371
Practice Address - Country:US
Practice Address - Phone:360-377-6136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator