Provider Demographics
NPI:1962074773
Name:JOHNSON-CHOONG, SHELLY LEE (MSW)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:LEE
Last Name:JOHNSON-CHOONG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9395 LINDER WAY NW STE 202
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-9149
Mailing Address - Country:US
Mailing Address - Phone:360-710-2484
Mailing Address - Fax:
Practice Address - Street 1:9395 LINDER WAY NW STE 202
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-9149
Practice Address - Country:US
Practice Address - Phone:360-710-2484
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASC609151791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical