Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103K00000X | Behavior Analyst | ||
N | 106E00000X | Assistant Behavior Analyst | ||
N | 106S00000X | Behavior Technician | CB60799981 | WA |
NPI | 1114433356 |
---|---|
Provider Name | Alyssa Johnson |
First Address | Cambridge, IL 61238-9248 |
Second Address | Burlington, IA 52601-2256 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2017 |
Last Update Date | 09/07/2020 |