Provider Demographics
NPI:1386720829
Name:JOHNSON, VELMA (LMP, CM, CDP, CPE)
Entity type:Individual
Prefix:
First Name:VELMA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMP, CM, CDP, CPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 ROAD 84 TRLR 128B
Mailing Address - Street 2:
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-1666
Mailing Address - Country:US
Mailing Address - Phone:509-947-9442
Mailing Address - Fax:
Practice Address - Street 1:404 BRADLEY BLVD STE 204
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-4500
Practice Address - Country:US
Practice Address - Phone:509-947-9442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00000815225700000X
WACP00004233171M00000X
247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator