MEDICARE: LAUREN 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	251C00000X	Developmentally Disabled Services Day Training Agency	1824431	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750984233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN JOHNSON

Provider Business Mailing Address
First Line	:	25601 N LAKELAND BLVD APT 106B
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2498
Country	:	US
Telephone Number	:	216-857-9831
Fax Number	:

Provider Business Practice Location Address
First Line	:	25601 N LAKELAND BLVD APT 106B
Second Line	:
City	:	EUCLID
State	:	OH
Zip	:	44132-2498
Country	:	US
Telephone Number	:	216-857-9831
Fax Number	:

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

Provider Enumeration Date	:	11/18/2020
Last Update Date	:	11/18/2020

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Directions to “ LAUREN JOHNSON ” Practice Location

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