Provider Demographics
NPI:1114585783
Name:JOHNSON, JONNICIA DANIELE
Entity Type:Individual
Prefix:
First Name:JONNICIA
Middle Name:DANIELE
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 1:7610 40TH ST W STE 300
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PL
Mailing Address - State:WA
Mailing Address - Zip Code:98466-3834
Mailing Address - Country:US
Mailing Address - Phone:253-830-6242
Mailing Address - Fax:
Practice Address - Street 1:7610 40TH ST W STE 300
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PL
Practice Address - State:WA
Practice Address - Zip Code:98466-3834
Practice Address - Country:US
Practice Address - Phone:253-830-6242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician