Provider Demographics
NPI:1942521778
Name:JOHNSON, DEBORAH LYNN (M A)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:M A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 UNIVERSITY AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SANDY
Mailing Address - State:OR
Mailing Address - Zip Code:97055-9290
Mailing Address - Country:US
Mailing Address - Phone:503-939-2475
Mailing Address - Fax:503-661-1196
Practice Address - Street 1:17150 UNIVERSITY AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SANDY
Practice Address - State:OR
Practice Address - Zip Code:97055-9290
Practice Address - Country:US
Practice Address - Phone:503-939-2475
Practice Address - Fax:503-661-1196
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional