Healthcare Provider Details

I. General information

NPI: 1720917651
Provider Name (Legal Business Name): JAMIE L JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3761 N 26TH ST
MILWAUKEE WI
53206-1337
US

IV. Provider business mailing address

3761 N 26TH ST
MILWAUKEE WI
53206-1337
US

V. Phone/Fax

Practice location:
  • Phone: 414-531-5502
  • Fax: 414-531-5502
Mailing address:
  • Phone: 414-531-5502
  • Fax: 414-531-5502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: