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General NPI Number Information
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NPI Number | 1922645746
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Entity Type | Individual
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Provider Name | LAUREN JOHNSON BCBA 1-22-59104
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Gender | Female
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Dates
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Enumeration Date | 12/01/2019
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 16649 JEAN LN APT 2S
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City | TINLEY PARK
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State | IL
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Zip | 60477-4964
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Country | US
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Telephone | 708-268-0468
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Fax |
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Provider Business Mailing Address
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Address Line | 7604 W SAINT FRANCIS RD
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City | FRANKFORT
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State | IL
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Zip | 60423-6931
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Country | US
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Telephone | 708-268-0468
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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 | 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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