Provider Demographics
NPI:1184909186
Name:JOHNSON, WENDY ANNE (BCBA)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 HOTCHKISS ST
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-1720
Mailing Address - Country:US
Mailing Address - Phone:716-998-1091
Mailing Address - Fax:
Practice Address - Street 1:80 HOTCHKISS ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-1720
Practice Address - Country:US
Practice Address - Phone:716-998-1091
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst