Provider Demographics
NPI:1043587041
Name:JOHNSTONE, VERONICA C (BA)
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:C
Last Name:JOHNSTONE
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10313 SW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97223-3744
Mailing Address - Country:US
Mailing Address - Phone:503-726-3698
Mailing Address - Fax:
Practice Address - Street 1:10313 SW 69TH AVE
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97223-9103
Practice Address - Country:US
Practice Address - Phone:503-726-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-19
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service