Provider Demographics
NPI:1194197293
Name:JOHNSON, CATHERINE (PSYD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3990 COLLINS WAY
Mailing Address - Street 2:STE 202
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-3459
Mailing Address - Country:US
Mailing Address - Phone:503-675-2830
Mailing Address - Fax:503-675-2852
Practice Address - Street 1:3990 COLLINS WAY
Practice Address - Street 2:STE 202
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-3459
Practice Address - Country:US
Practice Address - Phone:503-675-2830
Practice Address - Fax:503-675-2852
Is Sole Proprietor?:No
Enumeration Date:2015-10-28
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2806103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical