Individual
DEIAGAH JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3333 UNIVERSITY AVE SE # 55414, MINNEAPOLIS, MN 55414-3325
(612) 331-9413
Mailing address
1507 E 22ND ST, MINNEAPOLIS, MN 55404-3018
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/03/2023
Last updated
07/03/2023
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