Individual
JENNIFER ELLYN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
935 PARK AVE, #206, CRANSTON, RI 02910-2722
(401) 439-2580
Mailing address
26 JERRY LN, NORTH KINGSTOWN, RI 02852-2310
(401) 439-2580
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS00925
RI
Other
Enumeration date
01/08/2007
Last updated
07/08/2007
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