Healthcare Provider Details

I. General information

NPI: 1497544423
Provider Name (Legal Business Name): ALICIA VIRGINIA JOHNSON PRS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2025
Last Update Date: 05/05/2025
Certification Date: 05/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12201 EUCLID AVE
CLEVELAND OH
44106-4310
US

IV. Provider business mailing address

5227 W 148TH ST
BROOKPARK OH
44142-1720
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-4010
  • Fax:
Mailing address:
  • Phone: 216-926-1716
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberAPS.000895
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: