Provider Demographics
NPI:1881845279
Name:JOHNSON, ALICIA ANNE (ND)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 W 121ST TER
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1563
Mailing Address - Country:US
Mailing Address - Phone:913-375-0298
Mailing Address - Fax:
Practice Address - Street 1:8700 W 121ST TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1563
Practice Address - Country:US
Practice Address - Phone:913-375-0298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-04
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2100021175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath