Individual provider Active NPI

Katie Johnson, LSWAIC

  • Clinical Social Worker
  • Portland, OR
National Provider Identifier
1982335832
Registry record updated Jun 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
61155587 Issued in WA
Practice address
2104 SE Morrison St
Portland, OR 97214-2825
Phone
(971) 285-6545
NPI assigned
Jun 21, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 61155587 WA Primary

Addresses

Primary practice location

2104 SE Morrison St
Portland, OR 97214-2825

Mailing address

2104 SE Morrison St
Portland, OR 97214-2825
Phone (971) 285-6545

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241111001281 OR Practitioner - Clinical Social Worker 4183158355 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
61155587WAMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Alliance Counseling Center, Inc CurrentSince Sep 7, 2024 Accepting new patients
The DBT Clinic, PC CurrentSince Jun 26, 2022 Accepting new patients

Locations

2104 SE Morrison St
Portland, OR 97214
Phone (503) 875-4836

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1655769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655769600000",
    "number": "1982335832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 SE MORRISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142825",
            "telephone_number": "971-285-6545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 SE MORRISON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142825",
            "telephone_number": "971-285-6545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KATIE",
        "credential": "LSWAIC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-21",
        "last_updated": "2022-06-21",
        "certification_date": "2022-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "61155587",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.