Provider Demographics
NPI:1609132141
Name:JOHNSON, REBECCA COWAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:COWAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1259 COPPER CREST
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98229-3126
Mailing Address - Country:US
Mailing Address - Phone:360-312-7708
Mailing Address - Fax:
Practice Address - Street 1:1116 KEY ST
Practice Address - Street 2:SUITE 213
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-5232
Practice Address - Country:US
Practice Address - Phone:360-312-7708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-10
Last Update Date:2012-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY 3721103T00000X
CAPSY 10631103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist