Individual
WILFORD JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSS, CRM
Contact information
Practice address
3311 NE MARTIN LUTHER KING JR BLVD STE 104, PORTLAND, OR 97212-2086
(503) 206-8856
Mailing address
3311 NE MARTIN LUTHER KING JR BLVD STE 104, PORTLAND, OR 97212-2086
(503) 206-8856
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
THW000004160
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
THW000004160
OREGON HEALTH AUTHORITY
OR
Enumeration date
04/18/2020
Last updated
04/18/2020
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