Provider Demographics
NPI:1992351084
Name:JOHNSON, MATTIE KATHLEEN (ND)
Entity type:Individual
Prefix:DR
First Name:MATTIE
Middle Name:KATHLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:DR
Other - First Name:MATTIE
Other - Middle Name:
Other - Last Name:BLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:9327 4TH ST NE STE 9
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-1630
Mailing Address - Country:US
Mailing Address - Phone:360-291-6005
Mailing Address - Fax:
Practice Address - Street 1:9327 4TH ST NE STE 9
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-1630
Practice Address - Country:US
Practice Address - Phone:360-291-6005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-14
Last Update Date:2023-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath