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General NPI Number Information
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NPI Number | 1114433356
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Entity Type | Individual
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Provider Name | ALYSSA JOHNSON MA, BCBA
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Gender | Female
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Dates
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Enumeration Date | 12/26/2017
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Last Update Date | 07/09/2020
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Provider Practice Location Address
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Address Line | 2209 NORTHERN DR
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City | BURLINGTON
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State | IA
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Zip | 52601-2256
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Country | US
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Telephone | 319-243-1524
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Fax |
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Provider Business Mailing Address
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Address Line | 7058 N 850TH AVE
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City | CAMBRIDGE
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State | IL
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Zip | 61238-9248
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Country | US
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Telephone | 309-525-0611
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB60799981
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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