Provider Demographics
NPI:1548513872
Name:JOHNSTON, SIENNA SUMMER
Entity type:Individual
Prefix:
First Name:SIENNA
Middle Name:SUMMER
Last Name:JOHNSTON
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 1:2500 VALLEJO ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-6957
Mailing Address - Country:US
Mailing Address - Phone:707-546-7907
Mailing Address - Fax:707-546-1544
Practice Address - Street 1:2500 VALLEJO ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-6957
Practice Address - Country:US
Practice Address - Phone:707-546-7907
Practice Address - Fax:707-546-1544
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical