Active NPI
Diane Elizabeth Johnson, PH.D.
- Clinical Psychologist
- Port Hadlock, WA
National Provider Identifier
1255546768
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PY00001854
- Practice address
- 219 W Patison St
Port Hadlock, WA 98339-9710 - Phone
- (360) 379-8821
- Fax
- (360) 379-8821
- NPI assigned
- May 10, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY00001854 | WA | Primary |
Addresses
Primary practice location
219 W Patison St
Port Hadlock, WA 98339-9710
Mailing address
P.O. Box 37
Port Hadlock, WA 98339
Phone (360) 379-8821
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7110810 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120419000694 | WA | Practitioner - Clinical Psychologist | 1254592108 | Practice locations: Port Hadlock, WA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1979
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
219 W Patison St
Suite C
Port Hadlock, WA 98339-9711
Phone (360) 379-8821
PO Box
Suite 37
Port Hadlock, WA 98339
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY00001854 | WA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322438400000",
"number": "1255546768",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "P.O. BOX 37",
"city": "PORT HADLOCK",
"state": "WA",
"postal_code": "98339",
"telephone_number": "360-379-8821",
"fax_number": "360-379-8821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "219 W PATISON ST",
"city": "PORT HADLOCK",
"state": "WA",
"postal_code": "983399710",
"telephone_number": "360-379-8821",
"fax_number": "360-379-8821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "DIANE",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-10",
"last_updated": "2011-11-28",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "WA",
"license": "PY00001854",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7110810",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Port Hadlock, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.