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NPI Code Detail

MEDICARE: LINDSEY MARIE JOHNSON BCBA

MEDICARE: LINDSEY MARIE JOHNSON 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 Analyst1-19-38120
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1710487020
Entity Type Code : Individual
Provider Name (Legal Business Name) : LINDSEY MARIE JOHNSON BCBA
Provider Business Mailing Address
First Line : 1316 W DRAGOON TRL
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-4713
Country : US
Telephone Number : 574-314-0843
Fax Number :
Provider Business Practice Location Address
First Line : 1316 W DRAGOON TRL
Second Line :
City : MISHAWAKA
State : IN
Zip : 46544-4713
Country : US
Telephone Number : 574-314-4655
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2018
Last Update Date : 10/07/2019

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