MEDICARE: RAVEN 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	106S00000X	Behavior Technician		CA

General Provider Information

NPI Number	:	1285592469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RAVEN JOHNSON

Provider Business Mailing Address
First Line	:	402 CRIMSON CIR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-7630
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	402 CRIMSON CIR
Second Line	:
City	:	VACAVILLE
State	:	CA
Zip	:	95687-7630
Country	:	US
Telephone Number	:	808-743-8312
Fax Number	:	808-743-8312

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

Provider Enumeration Date	:	01/14/2026
Last Update Date	:	01/14/2026

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Directions to “ RAVEN JOHNSON ” Practice Location

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