Provider Demographics
NPI:1841727526
Name:JOHNSON, SOLOMON JAYE
Entity type:Individual
Prefix:MR
First Name:SOLOMON
Middle Name:JAYE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 COREY DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-3921
Mailing Address - Country:US
Mailing Address - Phone:209-666-4994
Mailing Address - Fax:
Practice Address - Street 1:3225 COREY DR
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-3921
Practice Address - Country:US
Practice Address - Phone:209-666-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-12
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV$$$$$$$$$Medicaid