Provider Demographics
NPI:1346265741
Name:JOHNSON, SCOTT G (AUD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21323 SW SHERWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97140-9218
Mailing Address - Country:US
Mailing Address - Phone:503-625-4111
Mailing Address - Fax:503-625-9879
Practice Address - Street 1:21323 SW SHERWOOD BLVD
Practice Address - Street 2:
Practice Address - City:SHERWOOD
Practice Address - State:OR
Practice Address - Zip Code:97140-9218
Practice Address - Country:US
Practice Address - Phone:503-625-4111
Practice Address - Fax:503-625-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR975241237700000X
OR21527231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist