Provider Demographics
NPI:1659815843
Name:JOHNSTON, JENNY (MS IN EDUCATION)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS IN EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1863 DISCOVERY DR
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1000
Mailing Address - Country:US
Mailing Address - Phone:954-588-4066
Mailing Address - Fax:
Practice Address - Street 1:1863 DISCOVERY DR
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1000
Practice Address - Country:US
Practice Address - Phone:954-588-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222Q00000XMedicaid