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NPI Code Detail

MEDICARE: MS. JENNIFER ANNE JOHNSTON BCBA

MEDICARE:  MS. JENNIFER ANNE JOHNSTON  BCBA
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 Analyst01-03-1204FL

General Provider Information

NPI Number : 1588960256
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. JENNIFER ANNE JOHNSTON BCBA
Provider Business Mailing Address
First Line : 360 POLK ST
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-1623
Country : US
Telephone Number : 317-888-1557
Fax Number : 317-888-1571
Provider Business Practice Location Address
First Line : 360 POLK ST
Second Line :
City : GREENWOOD
State : IN
Zip : 46143-1623
Country : US
Telephone Number : 317-888-1557
Fax Number : 317-888-1571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2011
Last Update Date : 01/28/2011

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Directions to “ MS. JENNIFER ANNE JOHNSTON BCBA” Practice Location

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