MEDICARE: ELIZABETH CHRISTINE 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	103K00000X	Behavior Analyst	2025012320	MO

General Provider Information

NPI Number	:	1356120620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CHRISTINE JOHNSON

Provider Business Mailing Address
First Line	:	5 NORTH ST
Second Line	:
City	:	LOUISBURG
State	:	MO
Zip	:	65685-9147
Country	:	US
Telephone Number	:	573-855-2668
Fax Number	:

Provider Business Practice Location Address
First Line	:	1701 TROOST AVE
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64108-1540
Country	:	US
Telephone Number	:	719-356-2737
Fax Number	:

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

Provider Enumeration Date	:	09/26/2023
Last Update Date	:	05/12/2026

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