Individual
DYLAN WADE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
925 STATE ROUTE VV, KENNETT, MO 63857-3822
(573) 888-5925
Mailing address
925 STATE ROUTE VV, KENNETT, MO 63857-3822
(573) 888-5925
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
05/16/2023
Last updated
05/16/2023
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