Provider Demographics
NPI:1043781024
Name:JOHNSTONE, JASON B (CDP)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:B
Last Name:JOHNSTONE
Suffix:
Gender:M
Credentials:CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13807 69TH AVENUE CT E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98373-8721
Mailing Address - Country:US
Mailing Address - Phone:253-691-0398
Mailing Address - Fax:
Practice Address - Street 1:10215 214TH AVE E
Practice Address - Street 2:
Practice Address - City:BONNEY LAKE
Practice Address - State:WA
Practice Address - Zip Code:98391-3909
Practice Address - Country:US
Practice Address - Phone:253-862-7374
Practice Address - Fax:253-862-0448
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60288139101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)