Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst |
NPI | 1073180204 |
---|---|
Provider Name | Abby Johnson |
First Address | Waunakee, WI 53597-2354 |
Second Address | Minneapolis, MN 55414-3325 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2021 |
Last Update Date | 07/06/2021 |