Provider Demographics
NPI:1033394994
Name:JOHNSEN, SARA BETH (MS, CGC)
Entity Type:Individual
Prefix:MR
First Name:SARA
Middle Name:BETH
Last Name:JOHNSEN
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8403 SE 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-7406
Mailing Address - Country:US
Mailing Address - Phone:503-502-5743
Mailing Address - Fax:503-494-2759
Practice Address - Street 1:3181 SW SAM JACKSON PARK RD
Practice Address - Street 2:L458
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3011
Practice Address - Country:US
Practice Address - Phone:503-418-2432
Practice Address - Fax:503-494-5296
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS