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General NPI Number Information
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NPI Number | 1003189242
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Entity Type | Individual
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Provider Name | ANGELA PAO-JOHNSON BCBA
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Gender | Female
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 10/14/2020
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Provider Practice Location Address
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Address Line | 125 HAYMEADOW DR
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City | CRANDALL
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State | TX
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Zip | 75114-5138
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Country | US
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Telephone | 346-330-0308
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Fax |
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Provider Business Mailing Address
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Address Line | 306 N KENSINGTON AVE
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City | LA GRANGE
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State | IL
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Zip | 60526-1870
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Country | US
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Telephone | 346-330-0308
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-09-6526
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License Number State | CA
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