Provider Demographics
NPI:1699847061
Name:JOHNSON, SARAH KJERSTEN (RD)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:KJERSTEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 NE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045-7920
Mailing Address - Country:US
Mailing Address - Phone:206-205-1674
Mailing Address - Fax:206-205-1711
Practice Address - Street 1:3001 NE 4TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-4122
Practice Address - Country:US
Practice Address - Phone:206-205-1674
Practice Address - Fax:206-205-1711
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADI00001586133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8389082Medicaid