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1679217905
IKE JOHNSON
GRANTS PASS, OR
NPI
1679217905
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
Enumeration Date
2022-04-22
Last Update Date
2022-04-22
Business Address
IKE JOHNSON
109 NE MANZANITA AVE
GRANTS PASS, OR 97526-1400
Phone number: 541-476-2373
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Mailing Address
IKE JOHNSON
1215 SW G ST
GRANTS PASS, OR 97526-2544
Phone number: 541-476-2373
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