Provider Demographics
NPI:1447761564
Name:PORTINGA, JOHANNA MAE (LSWAIC, MSW, CDPT)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MAE
Last Name:PORTINGA
Suffix:
Gender:F
Credentials:LSWAIC, MSW, CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 2ND AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1102
Mailing Address - Country:US
Mailing Address - Phone:206-495-5716
Mailing Address - Fax:206-448-8495
Practice Address - Street 1:1902 2ND AVE STE 208
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1186
Practice Address - Country:US
Practice Address - Phone:206-735-8738
Practice Address - Fax:206-448-8495
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2019-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program