Individual
MRS. IRENE ANNETTE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
73265 CONFEDERATED WAY, PENDLETON, OR 97801
(541) 966-9830
Mailing address
73493 HIGHWAY 331, PENDLETON, OR 97801-6000
(541) 966-8317
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
01-07-20
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
171037
—
OR
Enumeration date
09/21/2006
Last updated
07/08/2007
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