Individual
D JLA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1033 LARCHWOOD RD, MANSFIELD, OH 44907-2424
(419) 747-4122
Mailing address
455 S MAIN ST, MANSFIELD, OH 44907-5003
(419) 295-0051
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
US222998
OH
Other
Enumeration date
03/04/2020
Last updated
03/04/2020
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