MEDICARE: DELLA 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	103K00000X	Behavior Analyst	2026012474	MO
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1962395368
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DELLA JOHNSON

Provider Business Mailing Address
First Line	:	1972 INNERBELT BUSINESS CENTER DR
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-5760
Country	:	US
Telephone Number	:	314-202-4002
Fax Number	:	415-406-3316

Provider Business Practice Location Address
First Line	:	1972 INNERBELT BUSINESS CENTER DR
Second Line	:
City	:	OVERLAND
State	:	MO
Zip	:	63114-5760
Country	:	US
Telephone Number	:	314-202-4002
Fax Number	:	415-406-3316

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

Provider Enumeration Date	:	06/03/2025
Last Update Date	:	06/02/2026

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Directions to “ DELLA JOHNSON ” Practice Location

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