Provider Demographics
NPI:1639677602
Name:JOHNSON, KRISTIN COLLEEN (EDD, BCBA, LBS)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:COLLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:EDD, BCBA, LBS
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:COLLEEN
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:TELFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18969-1204
Mailing Address - Country:US
Mailing Address - Phone:215-527-1669
Mailing Address - Fax:267-382-0795
Practice Address - Street 1:20 CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:TELFORD
Practice Address - State:PA
Practice Address - Zip Code:18969-1204
Practice Address - Country:US
Practice Address - Phone:215-527-1669
Practice Address - Fax:267-382-0795
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH003632103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst