Individual
KIMI JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
705 CROSS ST, LAKEWOOD, NJ 08701-4029
(541) 808-1463
Mailing address
705 CROSS ST, LAKEWOOD, NJ 08701-4029
(541) 808-1463
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BACB748483
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BACB748483
BCBA
—
Enumeration date
05/10/2025
Last updated
06/24/2025
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