Provider Demographics
NPI:1124148655
Name:JOHNSON, JILL A (LMP)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:HEALING
Other - Middle Name:
Other - Last Name:MASSAGE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:800 NE TENNEY RD
Mailing Address - Street 2:#110-531
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2831
Mailing Address - Country:US
Mailing Address - Phone:360-601-0111
Mailing Address - Fax:360-546-2473
Practice Address - Street 1:9106 NE HIGHWAY 99 STE H
Practice Address - Street 2:SUITE H
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98665-8949
Practice Address - Country:US
Practice Address - Phone:360-601-0111
Practice Address - Fax:360-546-2473
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA0020602225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist