MEDICARE: JULIANNE JOHNSON BCABA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	0-14-5916	CO

General Provider Information

NPI Number	:	1376931840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNE JOHNSON BCABA

Provider Business Mailing Address
First Line	:	1118 N ARCADIA ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2639
Country	:	US
Telephone Number	:	720-384-5312
Fax Number	:	719-227-1042

Provider Business Practice Location Address
First Line	:	1118 N ARCADIA ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2639
Country	:	US
Telephone Number	:	720-384-5312
Fax Number	:	719-227-1042

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/06/2015
Last Update Date	:	01/06/2015

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