Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 3063 | OR |
NPI | 1083087498 |
---|---|
Provider Name | Dr. Jennifer Leigh Johnson |
First Address | Portland, OR 97209-1515 |
Second Address | Portland, OR 97209-1515 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2015 |
Last Update Date | 02/12/2015 |