Provider Demographics
NPI:1225536212
Name:JOHNSON, AUSTIN J
Entity Type:Individual
Prefix:
First Name:AUSTIN
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 COMMERCIAL ST NE STE 214
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-4082
Mailing Address - Country:US
Mailing Address - Phone:971-600-0980
Mailing Address - Fax:
Practice Address - Street 1:223 COMMERCIAL ST NE STE 214
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-4082
Practice Address - Country:US
Practice Address - Phone:971-600-0980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL107941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical