Healthcare Provider Details

I. General information

NPI: 1922875657
Provider Name (Legal Business Name): BRYN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2023
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4023 KENNETT PIKE # 988
WILMINGTON DE
19807-2018
US

IV. Provider business mailing address

11 ALLANDALE DR APT L11
NEWARK DE
19713-3192
US

V. Phone/Fax

Practice location:
  • Phone: 402-398-8198
  • Fax:
Mailing address:
  • Phone: 484-577-9928
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: