Provider Demographics
NPI:1033373220
Name:JOHNSON, ELIZABETH IRWIN
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:IRWIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7230 SW VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-3037
Mailing Address - Country:US
Mailing Address - Phone:971-404-6442
Mailing Address - Fax:
Practice Address - Street 1:17360 HOLY NAMES DR
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-5133
Practice Address - Country:US
Practice Address - Phone:503-675-2004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2011-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR254224225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist