Individual
TRISTIE KAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2330 NE SISKIYOU ST, PORTLAND, OR 97212-2471
(503) 528-0757
Mailing address
17740 SE HARRISON ST, PORTLAND, OR 97233-5122
(503) 265-8890
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
02/11/2008
Last updated
02/11/2008
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