Provider Demographics
NPI:1275137788
Name:JOHNSON, PAIGE BARBARA (RBT)
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:BARBARA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 3 MILE RD NW STE C
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49544-8251
Mailing Address - Country:US
Mailing Address - Phone:616-840-8807
Mailing Address - Fax:616-840-9684
Practice Address - Street 1:1550 3 MILE RD NW STE C
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49544-8251
Practice Address - Country:US
Practice Address - Phone:616-840-8807
Practice Address - Fax:616-840-9684
Is Sole Proprietor?:No
Enumeration Date:2020-11-24
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant