Healthcare Provider Details

I. General information

NPI: 1699621581
Provider Name (Legal Business Name): AHKIRIAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2026
Last Update Date: 03/09/2026
Certification Date: 03/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 MERRITT BLVD STE 25
TRUMBULL CT
06611-5450
US

IV. Provider business mailing address

45 SHERIDAN ST APT C
BRIDGEPORT CT
06610-2765
US

V. Phone/Fax

Practice location:
  • Phone: 475-308-6181
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number079934735
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: