Provider Demographics
NPI:1497649263
Name:JOHNSON, SARA (CES)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68830 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:SISTERS
Mailing Address - State:OR
Mailing Address - Zip Code:97759-9601
Mailing Address - Country:US
Mailing Address - Phone:503-939-9103
Mailing Address - Fax:
Practice Address - Street 1:68830 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:SISTERS
Practice Address - State:OR
Practice Address - Zip Code:97759-9601
Practice Address - Country:US
Practice Address - Phone:503-939-9103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-05
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach
No174H00000XOther Service ProvidersHealth Educator
No174400000XOther Service ProvidersSpecialist