Individual
ASHLEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LA
Contact information
Practice address
996 NW CIRCLE BLVD STE 103, CORVALLIS, OR 97330-1485
(541) 768-4370
(541) 768-9790
Mailing address
996 NW CIRCLE BLVD STE 103, CORVALLIS, OR 97330-1485
(541) 768-4370
(541) 768-9790
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
COS- FT- 10119169
OR
Other
Enumeration date
05/18/2016
Last updated
05/18/2016
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