Provider Demographics
NPI:1679809776
Name:JOHNSON, JEANNE PAULY (MD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:PAULY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:PAULY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2386 NW HOYT STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210
Mailing Address - Country:US
Mailing Address - Phone:503-228-5909
Mailing Address - Fax:503-226-4186
Practice Address - Street 1:2386 NW HOYT ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3219
Practice Address - Country:US
Practice Address - Phone:503-228-5909
Practice Address - Fax:503-226-4186
Is Sole Proprietor?:No
Enumeration Date:2009-10-23
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1096632084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry