Individual
EDNA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6217 BAYOU BLACK DR, GIBSON, LA 70356
(337) 636-0266
Mailing address
PO BOX 277, GIBSON, LA 70356-0277
(337) 636-0266
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4193
—
LA
Enumeration date
08/17/2022
Last updated
08/17/2022
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