Provider Demographics
NPI:1184775918
Name:JOHNSON, HEATHER J (MA)
Entity type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:677 WOODLAND SQUARE LOOP SE
Mailing Address - Street 2:SUITE 1 & 4
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1000
Mailing Address - Country:US
Mailing Address - Phone:360-820-2934
Mailing Address - Fax:
Practice Address - Street 1:677 WOODLAND SQUARE LOOP SE
Practice Address - Street 2:SUITE 1 & 4
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1000
Practice Address - Country:US
Practice Address - Phone:360-820-2934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARC106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist