Provider Demographics
NPI:1184007189
Name:JOHNSON, SARAH (BCBA)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:MOHON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:818 WINIFRED ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-3062
Mailing Address - Country:US
Mailing Address - Phone:517-513-3617
Mailing Address - Fax:517-513-3617
Practice Address - Street 1:818 WINIFRED ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202
Practice Address - Country:US
Practice Address - Phone:517-513-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst