Individual
TARA NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
401 E 3RD ST STE 101, THE DALLES, OR 97058-2563
(541) 298-2101
Mailing address
401 E 3RD ST STE 101, THE DALLES, OR 97058-2563
(541) 298-2101
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/02/2021
Last updated
07/02/2021
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