MEDICARE: VINCENT VESHAWN 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	175T00000X	Peer Specialist	1629690920	OH

General Provider Information

NPI Number	:	1124964267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT VESHAWN JOHNSON

Provider Business Mailing Address
First Line	:	9623 PARKVIEW AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4703
Country	:	US
Telephone Number	:	380-266-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	9623 PARKVIEW AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44104-4703
Country	:	US
Telephone Number	:	216-538-9802
Fax Number	:

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

Provider Enumeration Date	:	04/28/2026
Last Update Date	:	04/28/2026

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Directions to “ VINCENT VESHAWN JOHNSON ” Practice Location

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