Provider Demographics
NPI:1770864209
Name:JOHNSON, RESHA TRANELL (BSW)
Entity Type:Individual
Prefix:
First Name:RESHA
Middle Name:TRANELL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1911 BLUEGILL WAY
Mailing Address - Street 2:UNIT A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-0232
Mailing Address - Country:US
Mailing Address - Phone:818-428-0554
Mailing Address - Fax:
Practice Address - Street 1:1911 BLUEGILL WAY
Practice Address - Street 2:UNIT A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-0232
Practice Address - Country:US
Practice Address - Phone:818-428-0554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner