Provider Demographics
NPI:1982586665
Name:JOHNSON, LAVONDA LEEANN
Entity type:Individual
Prefix:MISS
First Name:LAVONDA
Middle Name:LEEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 N KILLINGSWORTH CT
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-2335
Mailing Address - Country:US
Mailing Address - Phone:971-997-3342
Mailing Address - Fax:
Practice Address - Street 1:717 N KILLINGSWORTH CT
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-2335
Practice Address - Country:US
Practice Address - Phone:971-997-3342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No374J00000XNursing Service Related ProvidersDoula
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool