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General NPI Number Information
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NPI Number | 1124489729
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Entity Type | Individual
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Provider Name | SARA JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 03/10/2016
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 520 N WALNUT ST
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City | DOVER
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State | OH
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Zip | 44622-2852
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Country | US
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Telephone | 330-364-7124
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Fax |
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Provider Business Mailing Address
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Address Line | 1324 GOSHEN AVE SE
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City | NEW PHILADELPHIA
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State | OH
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Zip | 44663-9377
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Country | US
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Telephone | 330-795-6229
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | OH1540804
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License Number State | OH
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