Provider Demographics
NPI:1396466975
Name:JOHNSON, JAMESON
Entity type:Individual
Prefix:
First Name:JAMESON
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 LEWIS AVE
Mailing Address - Street 2:
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310-2651
Mailing Address - Country:US
Mailing Address - Phone:360-536-3448
Mailing Address - Fax:
Practice Address - Street 1:3100 NW BUCKLIN HILL RD STE 215
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8363
Practice Address - Country:US
Practice Address - Phone:360-337-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-12
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician