MEDICARE: CORIE 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	171M00000X	Case Manager/Care Coordinator
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1104503960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CORIE JOHNSON

Provider Business Mailing Address
First Line	:	110 E BROWARD BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3525
Country	:	US
Telephone Number	:	588-556-1820
Fax Number	:

Provider Business Practice Location Address
First Line	:	110 E BROWARD BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3525
Country	:	US
Telephone Number	:	588-556-1820
Fax Number	:

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

Provider Enumeration Date	:	07/03/2023
Last Update Date	:	01/06/2025

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Directions to “ CORIE JOHNSON ” Practice Location

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