Individual
BETHANY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2240 PRAIRIE AVE, BELOIT, WI 53511-2648
(086) 361-7200
Mailing address
2240 PRAIRIE AVE, BELOIT, WI 53511-2648
(083) 616-7200
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
474579189001
—
IL
Enumeration date
12/18/2019
Last updated
02/09/2023
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