Provider Demographics
NPI:1467165597
Name:JOHNSON, CHLOE
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
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:PO BOX 14546
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98511-4546
Mailing Address - Country:US
Mailing Address - Phone:360-539-8487
Mailing Address - Fax:360-358-9944
Practice Address - Street 1:9333 MARTIN WAY E
Practice Address - Street 2:SUITE 214
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98516-5969
Practice Address - Country:US
Practice Address - Phone:360-539-8487
Practice Address - Fax:360-358-9944
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program