MEDICARE: JASON L JOHNSON

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	175T00000X	Peer Specialist

General Provider Information

NPI Number	:	1417820796
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON L JOHNSON

Provider Business Mailing Address
First Line	:	1157 WALDEN CT
Second Line	:
City	:	LEBANON
State	:	OH
Zip	:	45036-8827
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	526 XENIA AVE
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45410-1824
Country	:	US
Telephone Number	:	937-949-1524
Fax Number	:

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

Provider Enumeration Date	:	09/24/2025
Last Update Date	:	09/24/2025

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Directions to “ JASON L JOHNSON ” Practice Location

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