Provider Demographics
NPI:1912187378
Name:JOHNSON, CARLA (LMP)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2106 W CLEARVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-2331
Mailing Address - Country:US
Mailing Address - Phone:509-899-1959
Mailing Address - Fax:509-933-3658
Practice Address - Street 1:1206 N DOLARWAY RD
Practice Address - Street 2:SUITE # 211
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-8392
Practice Address - Country:US
Practice Address - Phone:509-925-6869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023300174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist