Provider Demographics
NPI:1548680903
Name:JOHNSON, JESSI K (MA)
Entity type:Individual
Prefix:
First Name:JESSI
Middle Name:K
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 1:349 16TH AVE E
Mailing Address - Street 2:202
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5143
Mailing Address - Country:US
Mailing Address - Phone:360-602-1276
Mailing Address - Fax:
Practice Address - Street 1:349 16TH AVE E
Practice Address - Street 2:202
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5143
Practice Address - Country:US
Practice Address - Phone:360-602-1276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMG60413313106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist