Provider Demographics
NPI:1629384441
Name:JOHNSON, TERRY DAVID
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:DAVID
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-5512
Mailing Address - Country:US
Mailing Address - Phone:360-532-8808
Mailing Address - Fax:360-532-8808
Practice Address - Street 1:1020 ANDERSON DR STE 202B
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:WA
Practice Address - Zip Code:98520-1055
Practice Address - Country:US
Practice Address - Phone:360-532-8808
Practice Address - Fax:360-612-3204
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAHA00000768237700000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist