Individual
TARREN NICOLE JOHNSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2785 EAGLE DR APT D202, AMMON, ID 83406-5725
(208) 419-2695
Mailing address
2785 EAGLE DR APT D202, AMMON, ID 83406-5725
(208) 419-2695
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
09/18/2021
Last updated
09/18/2021
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