Individual
MS. DEIDRE JENAE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC, LAT
Contact information
Practice address
515 3RD AVE, SEATTLE, WA 98104-2304
(206) 464-1570
Mailing address
119 GLENNWOOD PL NE, RENTON, WA 98056-5807
(206) 931-8776
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
WA
2255A2300X
Athletic Trainer
A161196040
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
01/10/2019
Last updated
05/19/2025
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