Provider Demographics
NPI:1881046100
Name:JOHNSON, JAQUAILA
Entity Type:Individual
Prefix:
First Name:JAQUAILA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E OLIVE ST
Mailing Address - Street 2:SOUND MENTAL HEALTH
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-2735
Mailing Address - Country:US
Mailing Address - Phone:206-302-2200
Mailing Address - Fax:206-302-2210
Practice Address - Street 1:204 111TH AVE NE
Practice Address - Street 2:SOUND MENTAL HEALTH
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-7530
Practice Address - Country:US
Practice Address - Phone:425-653-4956
Practice Address - Fax:206-726-5783
Is Sole Proprietor?:No
Enumeration Date:2016-07-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health