Provider Demographics
NPI:1972603918
Name:JOHNSON, PATRICK R (PHD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 NE BLAKELEY ST
Mailing Address - Street 2:SUITE 3B
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-3164
Mailing Address - Country:US
Mailing Address - Phone:425-238-9254
Mailing Address - Fax:
Practice Address - Street 1:2901 NE BLAKELEY ST
Practice Address - Street 2:SUITE 3B
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3164
Practice Address - Country:US
Practice Address - Phone:425-238-9254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1148103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical