Provider Demographics
NPI:1083324826
Name:JOHNSON, KATHERINE THERESA
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:THERESA
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 1:608 L PL SE
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-6204
Mailing Address - Country:US
Mailing Address - Phone:206-531-9729
Mailing Address - Fax:
Practice Address - Street 1:1101 ANDOVER PARK W STE 107
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-3911
Practice Address - Country:US
Practice Address - Phone:360-742-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-02
Last Update Date:2022-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health