Individual
JACOB BENJAMIN JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1233 EDGEWATER ST NW, SALEM, OR 97304-4049
(503) 378-7526
(503) 480-1611
Mailing address
1525 PLAZA ST NW, SALEM, OR 97304-4614
(503) 877-8567
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
THW000002220
OR
3747A0650X
Attendant Care Provider
—
—
Other
Enumeration date
10/15/2019
Last updated
07/23/2020
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