Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-17-7940 | MI |
NPI | 1013433846 |
---|---|
Provider Name | Mrs. Miranda L Johnson |
First Address | Brimley, MI 49715-9223 |
Second Address | Brimley, MI 49715-9223 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2017 |
Last Update Date | 14/08/2017 |