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NPI Code Detail

MEDICARE: HOLLY JOHNSON

MEDICARE: HOLLY JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1003439183
Entity Type Code : Individual
Provider Name (Legal Business Name) : HOLLY JOHNSON
Provider Business Mailing Address
First Line : 7121 HEATHERTON TRL
Second Line :
City : EDINA
State : MN
Zip : 55435-4120
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 6200 BURY DR
Second Line :
City : EDEN PRAIRIE
State : MN
Zip : 55346-1718
Country : US
Telephone Number : 866-822-7464
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2020
Last Update Date : 05/22/2020

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Directions to “ HOLLY JOHNSON ” Practice Location

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