Individual
VANESSA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
QMHA
Contact information
Practice address
805 NE RESERVOIR LN, TOLEDO, OR 97391-1335
(541) 336-2254
(541) 336-1803
Mailing address
805 NE RESERVOIR LN, TOLEDO, OR 97391-1335
(541) 336-2254
(541) 336-1803
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
106
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
93-0698327
PRIVATE NONPROFIT
OR
Enumeration date
05/18/2009
Last updated
05/18/2009
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