Individual
LISA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4455 NE HWY 20, CHILDREN'S FARM HOME, CORVALLIS, OR 97330
(541) 758-5975
Mailing address
740 ARCADIA DR, EUGENE, OR 97401-5317
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
9503141
OR
Other
Enumeration date
05/24/2007
Last updated
07/08/2007
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