Provider Demographics
NPI:1295329548
Name:JOHNSON, ADDISON QUINN (MS, CGC)
Entity type:Individual
Prefix:
First Name:ADDISON
Middle Name:QUINN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6200 N RIVER POINTE DR APT C206
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-1851
Mailing Address - Country:US
Mailing Address - Phone:208-407-3793
Mailing Address - Fax:
Practice Address - Street 1:900 N LIBERTY ST STE 206
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8729
Practice Address - Country:US
Practice Address - Phone:208-302-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS