MEDICARE: ARIELLE D 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
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1003646035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARIELLE D JOHNSON

Provider Business Mailing Address
First Line	:	610 E 200TH ST # UP
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44119-2353
Country	:	US
Telephone Number	:	832-916-5238
Fax Number	:

Provider Business Practice Location Address
First Line	:	13100 SHAKER SQ # C200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-2313
Country	:	US
Telephone Number	:	216-512-0321
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	08/05/2024

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