Provider Demographics
NPI:1083183958
Name:JOHNSON, ANNA MAY LORAINE (BC-HIS)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MAY LORAINE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-0272
Mailing Address - Country:US
Mailing Address - Phone:360-855-1207
Mailing Address - Fax:360-855-1407
Practice Address - Street 1:209 FERRY ST STE C
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1462
Practice Address - Country:US
Practice Address - Phone:360-855-1207
Practice Address - Fax:360-855-1407
Is Sole Proprietor?:No
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60859224237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA60859224OtherWASHINGTON STATE DEPARTMENT OF HEALTH HEARING AID SPECIALIST LICENSE