Healthcare Provider Details

I. General information

NPI: 1427965748
Provider Name (Legal Business Name): HANNAH BROOKE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 MALLETTS BAY AVE APT B
WINOOSKI VT
05404-1915
US

IV. Provider business mailing address

119 MALLETTS BAY AVE APT B
WINOOSKI VT
05404-1915
US

V. Phone/Fax

Practice location:
  • Phone: 802-505-9222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-23-292072
License Number StateVT
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-26-2842252
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: