MEDICARE: PAULA JOHNSTON

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

General Provider Information

NPI Number	:	1699214676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA JOHNSTON

Provider Business Mailing Address
First Line	:	245 LAKESIDE CT
Second Line	:	1021
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-7923
Country	:	US
Telephone Number	:	847-429-8223
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 LAKESIDE CT
Second Line	:	1021
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-7923
Country	:	US
Telephone Number	:	847-429-8223
Fax Number	:

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

Provider Enumeration Date	:	02/23/2017
Last Update Date	:	02/23/2017

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Directions to “ PAULA JOHNSTON ” Practice Location

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