Provider Demographics
NPI:1609138163
Name:JOHNSON, STEPHANIE ANN (BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:STEPHANIE
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 MAIN ST APT B
Mailing Address - Street 2:
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-6386
Mailing Address - Country:US
Mailing Address - Phone:907-220-7419
Mailing Address - Fax:907-225-1541
Practice Address - Street 1:445 MAIN ST APT B
Practice Address - Street 2:
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-6386
Practice Address - Country:US
Practice Address - Phone:907-220-7419
Practice Address - Fax:907-225-1541
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK173332103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst