MEDICARE: BREOSHA 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

General Provider Information

NPI Number	:	1629903729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREOSHA JOHNSON

Provider Business Mailing Address
First Line	:	920 SE 6TH ST APT A
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47713-1679
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7313 EAGLE CREST BLVD
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-8157
Country	:	US
Telephone Number	:	812-213-7350
Fax Number	:

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

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “ BREOSHA JOHNSON ” Practice Location

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