Active NPI
Deidre Jenae Johnson, ATC, LAT
- Counselor
- Seattle, WA
National Provider Identifier
1912470089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- Practice address
- 515 3Rd Ave
Seattle, WA 98104-2304 - Phone
- (206) 464-1570
- NPI assigned
- Jan 10, 2019
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | A161196040 | WA | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Counselor | 101Y00000X | WA | Primary |
Addresses
Primary practice location
515 3Rd Ave
Seattle, WA 98104-2304
Mailing address
119 Glennwood PL NE
Renton, WA 98056-5807
Phone (206) 931-8776
Other practice location 1
15810 39th Pl S Apt B13
Tukwila, WA 98188-2657
Phone (206) 931-8776
Other practice location 2
13425 SE 30th St Ste 2C
Bellevue, WA 98005-4450
Phone (425) 800-4488
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A161196040 | WA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1547078400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747612800000",
"number": "1912470089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "119 GLENNWOOD PL NE",
"city": "RENTON",
"state": "WA",
"postal_code": "980565807",
"telephone_number": "206-931-8776"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "515 3RD AVE",
"city": "SEATTLE",
"state": "WA",
"postal_code": "981042304",
"telephone_number": "206-464-1570"
}
],
"practiceLocations": [
{
"address_1": "15810 39th Pl S Apt B13",
"address_purpose": "LOCATION",
"city": "Tukwila",
"state": "WA",
"postal_code": "981882657",
"country_code": "US",
"telephone_number": "206-931-8776",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "13425 SE 30th St Ste 2C",
"address_purpose": "LOCATION",
"city": "Bellevue",
"state": "WA",
"postal_code": "980054450",
"country_code": "US",
"telephone_number": "425-800-4488",
"fax_number": "425-201-2380",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "JOHNSON",
"first_name": "DEIDRE",
"middle_name": "JENAE",
"name_prefix": "Ms.",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-01-10",
"last_updated": "2025-05-19",
"certification_date": "2025-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WA",
"license": "A161196040",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "WA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seattle, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.