Healthcare Provider Details

I. General information

NPI: 1285164327
Provider Name (Legal Business Name): JOHANNA TAYLOR BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 04/14/2023
Certification Date: 04/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 HEKAU ST
AIEA HI
96701-4222
US

IV. Provider business mailing address

1131 HEKAU ST
AIEA HI
96701-4222
US

V. Phone/Fax

Practice location:
  • Phone: 425-870-9311
  • Fax:
Mailing address:
  • Phone: 425-870-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number344
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-17-34576
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: