Healthcare Provider Details

I. General information

NPI: 1114886538
Provider Name (Legal Business Name): JAIDYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 PENNSYLVANIA AVE SE UNIT 15707
WASHINGTON DC
20003-7529
US

IV. Provider business mailing address

4450 RIVANNA RIVER WAY # 3069
FAIRFAX VA
22030-4441
US

V. Phone/Fax

Practice location:
  • Phone: 443-690-5857
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number103K00000K
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: