MEDICARE: MISS ANGIE JOHNSON ISAAC ED.S.

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	103TS0200X	School Psychologist		AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	076869	OTHER	AZ	AHCCCS PROVIDER NUMBER

General Provider Information

NPI Number	:	1760521694
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANGIE JOHNSON ISAAC ED.S.

Provider Business Mailing Address
First Line	:	1869 W MANOR ST
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85224-5108
Country	:	US
Telephone Number	:	480-786-0611
Fax Number	:

Provider Business Practice Location Address
First Line	:	2013 N 36TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-3026
Country	:	US
Telephone Number	:	602-381-6100
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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Directions to “ MISS ANGIE JOHNSON ISAAC ED.S.” Practice Location

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