Provider Demographics
NPI:1699214676
Name:JOHNSTON, PAULA
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LAKESIDE CT
Mailing Address - Street 2:1021
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-7923
Mailing Address - Country:US
Mailing Address - Phone:847-429-8223
Mailing Address - Fax:
Practice Address - Street 1:245 LAKESIDE CT
Practice Address - Street 2:1021
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-7923
Practice Address - Country:US
Practice Address - Phone:847-429-8223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst