Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-19-10592 |
NPI | 1124770219 |
---|---|
Provider Name | Ms. Rebecca Anne Johnson |
First Address | Riverton, IL 62561-9692 |
Second Address | Riverton, IL 62561-9692 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2022 |
Last Update Date | 20/01/2022 |