Individual
BRENDA JOHNSTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
904 S 16TH ST, MOUNT VERNON, WA 98274-4516
(360) 424-0755
Mailing address
904 S 16TH ST, MOUNT VERNON, WA 98274-4516
(360) 424-0755
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
MA00003980
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3529
LABOR AND INDUSTRIES
WA
Enumeration date
05/27/2008
Last updated
02/24/2009
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