MEDICARE: JALEESA NICOLE 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	101Y00000X	Counselor		OH

General Provider Information

NPI Number	:	1275479289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JALEESA NICOLE JOHNSON

Provider Business Mailing Address
First Line	:	5855 TAYLORSVILLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2670
Country	:	US
Telephone Number	:	937-823-8340
Fax Number	:

Provider Business Practice Location Address
First Line	:	5855 TAYLORSVILLE RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45424-2670
Country	:	US
Telephone Number	:	937-823-8340
Fax Number	:

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

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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Directions to “ JALEESA NICOLE JOHNSON ” Practice Location

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