Individual
DIXIE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
54-046 KAMEHAMEHA HWY, HAUULA, HI 96717-9647
(208) 550-4666
Mailing address
46-1013 EMEPELA WAY APT 19A, KANEOHE, HI 96744-6909
(208) 550-4666
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-86994
HI
Other
Enumeration date
08/09/2019
Last updated
08/09/2019
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