Sidney Yorke Johnson, SUDPT

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

CO61278752 Issued in WA

Practice address

15837 Otter Pond Dr
Mount Vernon, WA 98273-8548

Phone

(907) 227-6009

NPI assigned

May 12, 2022

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1652313600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652313600000",
    "number": "1336885201",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15837 OTTER POND DR",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982738548",
            "telephone_number": "907-227-6009"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15837 OTTER POND DR",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982738548",
            "telephone_number": "907-227-6009"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SIDNEY",
        "middle_name": "YORKE",
        "credential": "SUDPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-05-12",
        "last_updated": "2022-05-12",
        "certification_date": "2022-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO61278752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CO61278752",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sjohnson@evergreenrc.org",
            "affiliation": "N",
            "address_1": "15837 Otter Pond Dr",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982738548",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Eric R Johnson, M.S.
• Gary K Johnson, M.D.
• Lori Delight Johnson, DC
• Mark L. Johnson, MD
• Norman Lee Johnson, M.S.
• Steven H Johnson, M.D.
• William R Johnson, LICSW
• Zachary Ryan Johnson, PHARMD
• Brenda Johnston, LMP
• Catherine Bree Johnston

• Addiction (Substance Use Disorder) Counselor in Mount Vernon, WA
• Providers in Mount Vernon, WA by specialty
• Addiction (Substance Use Disorder) Counselor in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 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.