Provider Demographics
NPI:1891990388
Name:JOHNSON, AIMEE COUGHLIN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:COUGHLIN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:COUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5819 N. GREELEY AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217
Mailing Address - Country:US
Mailing Address - Phone:503-295-7337
Mailing Address - Fax:509-926-9161
Practice Address - Street 1:5819 N. GREELEY AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217
Practice Address - Country:US
Practice Address - Phone:503-295-7337
Practice Address - Fax:509-926-9161
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-15
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR38521041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical