Healthcare Provider Details

I. General information

NPI: 1346854353
Provider Name (Legal Business Name): RENEE JOHNSSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/09/2024
Certification Date: 08/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7634 CROSSWOODS DR
COLUMBUS OH
43235-4621
US

IV. Provider business mailing address

2000 AUBURN DR STE 200
BEACHWOOD OH
44122-4328
US

V. Phone/Fax

Practice location:
  • Phone: 380-799-8555
  • Fax:
Mailing address:
  • Phone: 888-830-1672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberCOBA.01468
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: