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1679058895 NPI number — KATELIN ANN JOHNSON BCBA

NPI Number: 1679058895
Health Care Provider/Practitioner: KATELIN ANN JOHNSON BCBA

Information about “1679058895” NPI (KATELIN ANN JOHNSON BCBA) exists in 1679058895 in HTML format HTML  |  1679058895 in plain Text format TXT  |  1679058895 in PDF (Portable Document Format) PDF  |  1679058895 in an XML format XML  formats.

NPI Number : 1679058895 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679058895",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOHNSON",
    "FirstName": "KATELIN",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BCBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "80 EASTWOOD DR APT 403",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SOUTH BURLINGTON",
    "MailingAddressStateName": "VT",
    "MailingAddressPostalCode": "05403-4521",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "253-509-2639",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "288 GALLISON HILL RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MONTPELIER",
    "PracticeLocationAddressStateName": "VT",
    "PracticeLocationAddressPostalCode": "05602-8352",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-223-6500",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/03/2018",
    "LastUpdateDate": "01/17/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106E00000X",
          "TaxonomyName": "Assistant Behavior Analyst",
          "LicenseNumber": "147.0123004",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "146.0134138",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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