Provider Demographics
NPI:1578848727
Name:JOHNSON, MAGGIE (MT-BC)
Entity Type:Individual
Prefix:
First Name:MAGGIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 SE LAFAYETTE ST APT 3
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-3854
Mailing Address - Country:US
Mailing Address - Phone:541-252-1530
Mailing Address - Fax:
Practice Address - Street 1:1330 SE LAFAYETTE ST APT 3
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-3854
Practice Address - Country:US
Practice Address - Phone:541-252-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2012-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist