Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 106S00000X | Behavior Technician |
NPI | 1003387408 |
---|---|
Provider Name | Jeshana Johnson |
First Address | Ontario, CA 91761-4238 |
Second Address | Ontario, CA 91761-4238 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2018 |
Last Update Date | 12/08/2019 |