Provider Demographics
NPI:1386226819
Name:JOHNSON, BETINA CLAUDIA
Entity Type:Individual
Prefix:
First Name:BETINA
Middle Name:CLAUDIA
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 1:1122 N 115TH ST APT B212
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-8355
Mailing Address - Country:US
Mailing Address - Phone:425-327-1976
Mailing Address - Fax:
Practice Address - Street 1:1122 N 115TH ST APT B212
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-8355
Practice Address - Country:US
Practice Address - Phone:425-327-1976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-23
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC11044171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter