Provider Demographics
NPI:1922179068
Name:JOHANNSEN, KARI
Entity type:Individual
Prefix:MRS
First Name:KARI
Middle Name:
Last Name:JOHANNSEN
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 1:1866 NW IOWA AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-1010
Mailing Address - Country:US
Mailing Address - Phone:541-301-6591
Mailing Address - Fax:
Practice Address - Street 1:2863 NW CROSSING DR STE 212
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97703-7190
Practice Address - Country:US
Practice Address - Phone:541-301-6591
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2024-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
ORL116221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty