Healthcare Provider Details

I. General information

NPI: 1629675814
Provider Name (Legal Business Name): SIERRA BROOKE JOHNSON MS, BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 ERIE PASS
AUBURN IN
46706
US

IV. Provider business mailing address

2767 E US HIGHWAY 6
KENDALLVILLE IN
46755-9341
US

V. Phone/Fax

Practice location:
  • Phone: 260-308-8901
  • Fax:
Mailing address:
  • Phone: 260-308-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: