Provider Demographics
NPI:1598118283
Name:JOHNSON, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
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 1:12295 NW BIG FIR CIR
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-3903
Mailing Address - Country:US
Mailing Address - Phone:503-431-1442
Mailing Address - Fax:
Practice Address - Street 1:205 SE 3RD AVE STE 100
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4087
Practice Address - Country:US
Practice Address - Phone:503-535-1150
Practice Address - Fax:503-693-6474
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-18
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No374J00000XNursing Service Related ProvidersDoula