Provider Demographics
NPI:1407290711
Name:JOHNSON, JENNIFER LYN (MS LLP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 E. EISENHOWER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108
Mailing Address - Country:US
Mailing Address - Phone:734-677-0070
Mailing Address - Fax:734-677-0890
Practice Address - Street 1:3200 E. EISENHOWER PKWY
Practice Address - Street 2:EISENHOWER CENTER
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108
Practice Address - Country:US
Practice Address - Phone:734-677-0070
Practice Address - Fax:734-677-0890
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301010450103K00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst