Annika Michele Johnson Campbell, PSYD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

3425 Issued in OR

Practice address

1175 Mount Hood Ave
Woodburn, OR 97071-9060

Phone

(509) 662-6000

NPI assigned

Apr 10, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 1

Other names 1

• Annika Michele Johnson Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mangata Wellness, Inc

  • Clinical Psychologist
  • Salem, OR
  • NPI 1790419158
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1554854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1083177604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1175 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719060",
            "telephone_number": "503-982-2000",
            "fax_number": "503-982-0660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1175 MOUNT HOOD AVE",
            "city": "WOODBURN",
            "state": "OR",
            "postal_code": "970719060",
            "telephone_number": "509-662-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON CAMPBELL",
        "first_name": "ANNIKA",
        "middle_name": "MICHELE",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-04-10",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "WA",
            "license": "MC60969986",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "WA",
            "license": "MC60969986",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "OR",
            "license": "3425",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2133958",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "ajohnsoncampbell35204@yvfwc.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "YVFWC Direct Email Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "1175 Mount Hood Ave",
            "city": "Woodburn",
            "state": "OR",
            "country_code": "US",
            "postal_code": "970719060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ANNIKA",
            "last_name": "JOHNSON",
            "middle_name": "MICHELE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Michael David Jackson
• Cole Janini
• Megan Anna Jantzi, SLP
• Dylan Jessen
• Marlon Johns, DC
• Sataj Johnson, MD
• Cassandra Dawn Jolley, RD
• Daniel Thomas Jones, MS.FNP
• Sharon Dallas Paoo Keaulana, PHARM D
• Steven Joseph Kempler, OTR/L

• Psychologist in Woodburn, OR
• Providers in Woodburn, OR by specialty
• Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.