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NPI Code Detail

MEDICARE: COLLEEN JOHNSON BCBA

MEDICARE: COLLEEN 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
1106S00000XBehavior Technician
2103K00000XBehavior AnalystMO

General Provider Information

NPI Number : 1841919404
Entity Type Code : Individual
Provider Name (Legal Business Name) : COLLEEN JOHNSON BCBA
Provider Business Mailing Address
First Line : 16629 WILD HORSE CREEK RD
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63005-1627
Country : US
Telephone Number : 636-777-8101
Fax Number : 636-777-8104
Provider Business Practice Location Address
First Line : 16629 WILD HORSE CREEK RD
Second Line :
City : CHESTERFIELD
State : MO
Zip : 63005-1627
Country : US
Telephone Number : 636-777-8101
Fax Number : 636-777-8104
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/25/2022
Last Update Date : 10/02/2023

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