Provider Demographics
NPI:1821559295
Name:JOHNSON, JABARI (BCAT)
Entity type:Individual
Prefix:
First Name:JABARI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:BCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 N CLINTON ST STE 440
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-2392
Mailing Address - Country:US
Mailing Address - Phone:312-315-9995
Mailing Address - Fax:
Practice Address - Street 1:118 N CLINTON ST STE 440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60661-2392
Practice Address - Country:US
Practice Address - Phone:312-315-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IL103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst