Provider Demographics
NPI:1649551185
Name:JOHNSON, KATHERINE (MT-BC)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13270 SW ALLEN BLVD
Mailing Address - Street 2:APT 3
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97005-4558
Mailing Address - Country:US
Mailing Address - Phone:801-879-2408
Mailing Address - Fax:
Practice Address - Street 1:13270 SW ALLEN BLVD
Practice Address - Street 2:APT 3
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97005-4558
Practice Address - Country:US
Practice Address - Phone:801-879-2408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist