Provider Demographics
NPI:1952080962
Name:JOHNSON, SHYANNE MARIE
Entity Type:Individual
Prefix:
First Name:SHYANNE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1662 JADWIN AVE APT B
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99354-2523
Mailing Address - Country:US
Mailing Address - Phone:509-845-7001
Mailing Address - Fax:
Practice Address - Street 1:1919 N PITTSBURG ST STE B
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7216
Practice Address - Country:US
Practice Address - Phone:509-233-4779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-17
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician