Provider Demographics
NPI:1154122901
Name:JOHNSON, CARLYN
Entity type:Individual
Prefix:
First Name:CARLYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:CARLYN
Other - Middle Name:
Other - Last Name:HEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1313 HEADLEY AVE NW
Mailing Address - Street 2:
Mailing Address - City:ORTING
Mailing Address - State:WA
Mailing Address - Zip Code:98360-9440
Mailing Address - Country:US
Mailing Address - Phone:253-409-9513
Mailing Address - Fax:
Practice Address - Street 1:1510 140TH AVE NE
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-4572
Practice Address - Country:US
Practice Address - Phone:425-543-7382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAB61641006106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst