Individual
KEVIN JOHNSON JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1825 MARIKA RD, FAIRBANKS, AK 99709-5521
(907) 474-0890
Mailing address
501 LILY DR APT 2, FORT WAINWRIGHT, AK 99703-1503
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
06/17/2020
Last updated
06/17/2020
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