Provider Demographics
NPI:1689198400
Name:JOHNSON, SHAWNTI (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SHAWNTI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15127 36TH DR SE
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6148
Mailing Address - Country:US
Mailing Address - Phone:425-780-6045
Mailing Address - Fax:
Practice Address - Street 1:15127 36TH DR SE
Practice Address - Street 2:
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98012-6148
Practice Address - Country:US
Practice Address - Phone:425-780-6045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-02
Last Update Date:2023-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW60827453101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALW60827463OtherLICENSED INDEPENDENT CLINICAL SOCIAL WORKER