MEDICARE: AHKIRIAH 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	079934735	CT

General Provider Information

NPI Number	:	1699621581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AHKIRIAH JOHNSON

Provider Business Mailing Address
First Line	:	45 SHERIDAN ST APT C
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-2765
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 MERRITT BLVD STE 25
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-5450
Country	:	US
Telephone Number	:	475-308-6181
Fax Number	:

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

Provider Enumeration Date	:	03/05/2026
Last Update Date	:	03/09/2026

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