Provider Demographics
NPI:1760655575
Name:JOHNSON-BEALE, CLOTILDE AMELIA (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:CLOTILDE
Middle Name:AMELIA
Last Name:JOHNSON-BEALE
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Gender:F
Credentials:MD, MPH
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Mailing Address - Street 1:505 NE 87TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-1989
Mailing Address - Country:US
Mailing Address - Phone:360-892-1635
Mailing Address - Fax:360-892-3146
Practice Address - Street 1:505 NE 87TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-1989
Practice Address - Country:US
Practice Address - Phone:360-892-1635
Practice Address - Fax:360-892-3146
Is Sole Proprietor?:No
Enumeration Date:2008-04-12
Last Update Date:2013-02-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD602735312080A0000X
ORMD1585702080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine