Provider Demographics
NPI:1841515814
Name:PLOUDE, JOHANNA E (MA, BCBA)
Entity type:Individual
Prefix:MS
First Name:JOHANNA
Middle Name:E
Last Name:PLOUDE
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 GREENWICH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3271
Mailing Address - Country:US
Mailing Address - Phone:310-892-1881
Mailing Address - Fax:
Practice Address - Street 1:2695 GREENWICH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94123-3271
Practice Address - Country:US
Practice Address - Phone:310-892-1881
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-08-4753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst