Individual
KATHLYN MARIE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMP
Contact information
Practice address
1815 D ST, VANCOUVER, WA 98663-3332
(360) 624-3100
Mailing address
10608 NE 36TH AVE, VANCOUVER, WA 98686-4333
(360) 624-3100
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00017681
WA
Other
Enumeration date
04/17/2007
Last updated
07/08/2007
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