Provider Demographics
NPI:1033471651
Name:JOHNSON, LINDA DIANE (LAC, EAMP)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LAC, EAMP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4000 NE 109TH AVE
Mailing Address - Street 2:UNIT 243
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-5799
Mailing Address - Country:US
Mailing Address - Phone:360-771-2608
Mailing Address - Fax:360-836-5348
Practice Address - Street 1:410 E 20TH ST
Practice Address - Street 2:ARNADA CLINIC
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3316
Practice Address - Country:US
Practice Address - Phone:360-771-2608
Practice Address - Fax:360-836-5348
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-10
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC 60038843171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist