Individual
RODNEY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6308 W COPPER LEAF DR, TUCSON, AZ 85757-7539
(630) 379-2523
Mailing address
994 S HARRISON RD, TUCSON, AZ 85748-6608
(520) 721-1887
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
9174681
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9174681
CHILDRENS BEHAVIORAL HEALTH THERAPEUTIC FOSTER CARE
AZ
Enumeration date
08/29/2018
Last updated
08/29/2018
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