Provider Demographics
NPI:1801276076
Name:JOHNSON, JAMIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 FAIRVIEW AVE E
Mailing Address - Street 2:STE 205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102
Mailing Address - Country:US
Mailing Address - Phone:303-241-8944
Mailing Address - Fax:
Practice Address - Street 1:1500 FAIRVIEW AVE E
Practice Address - Street 2:STE 205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3727
Practice Address - Country:US
Practice Address - Phone:206-325-9297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-03
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPSYC.PY.60534237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical