Provider Demographics
NPI:1366188187
Name:JOHNSON, ANNETTE LEANE (CADC-R)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:LEANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2238 NE BARBERRY CT
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5910
Mailing Address - Country:US
Mailing Address - Phone:971-341-6022
Mailing Address - Fax:
Practice Address - Street 1:10920 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-8600
Practice Address - Country:US
Practice Address - Phone:541-204-2849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-05
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-22-1477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)