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NPI Code Detail

MEDICARE: KATELYN JOHNSON

MEDICARE: KATELYN 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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1306792098
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATELYN JOHNSON
Provider Business Mailing Address
First Line : 32326 CLINTON KEITH RD STE 201
Second Line :
City : WILDOMAR
State : CA
Zip : 92595-7317
Country : US
Telephone Number : 858-264-5858
Fax Number :
Provider Business Practice Location Address
First Line : 32326 CLINTON KEITH RD STE 201
Second Line :
City : WILDOMAR
State : CA
Zip : 92595-7317
Country : US
Telephone Number : 858-264-5858
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ KATELYN JOHNSON ” Practice Location

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