Provider Demographics
NPI:1609152206
Name:JOHNSON, TUNISIA (CCC-A)
Entity Type:Individual
Prefix:
First Name:TUNISIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8800 SE SUNNYSIDE RD
Mailing Address - Street 2:STE. 300-N
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-5738
Mailing Address - Country:US
Mailing Address - Phone:503-659-5115
Mailing Address - Fax:503-659-5968
Practice Address - Street 1:133 ROLLINS AVE
Practice Address - Street 2:UNIT 2
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-4040
Practice Address - Country:US
Practice Address - Phone:301-468-7670
Practice Address - Fax:301-468-7620
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01242237600000X
DCAUD000124237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter