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General NPI Number Information
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NPI Number | 1477164606
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Entity Type | Individual
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Provider Name | RACHAEL JOHANSEN PPS CREDENTIAL
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Gender | Female
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Dates
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Enumeration Date | 08/12/2020
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Last Update Date | 08/12/2020
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Provider Practice Location Address
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Address Line | 501 NORCROSS LN
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City | OAKLEY
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State | CA
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Zip | 94561-2189
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Country | US
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Telephone | 925-625-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 1098 VILLAGE OAKS DR
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City | MARTINEZ
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State | CA
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Zip | 94553-4150
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Country | US
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Telephone | 619-787-2583
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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 | 200120163
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License Number State | CA
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