Provider Demographics
NPI:1902128788
Name:JOHNSON, JAMIE SUSANN
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SUSANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 DARYL PORTER WAY
Mailing Address - Street 2:1720 DARYL PORTER WAY
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-5315
Mailing Address - Country:US
Mailing Address - Phone:530-342-3100
Mailing Address - Fax:530-342-3995
Practice Address - Street 1:1720 DARYL PORTER WAY
Practice Address - Street 2:1720 DARYL PORTER WAY
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-5315
Practice Address - Country:US
Practice Address - Phone:530-342-3100
Practice Address - Fax:530-342-3995
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor