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General NPI Number Information
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NPI Number | 1104602176
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Entity Type | Individual
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Provider Name | CYDNEE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 9951 ATLANTIC BLVD STE 326
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City | JACKSONVILLE
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State | FL
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Zip | 32225-6579
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Country | US
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Telephone | 904-704-4321
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Fax |
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Provider Business Mailing Address
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Address Line | 109 AZALEA AVE
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City | FOLKSTON
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State | GA
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Zip | 31537-5857
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Country | US
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Telephone | 904-697-6338
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-23-296238
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License Number State | FL
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