Individual
TRACE ANDREW JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
1704 WESTLAND RD, CHEYENNE, WY 82001-3322
(605) 271-2690
(605) 271-3956
Mailing address
2804 E 26TH ST STE 1, SIOUX FALLS, SD 57103-4019
(605) 271-2690
(605) 271-2690
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-19-103651
WY
Other
Enumeration date
11/04/2019
Last updated
11/04/2019
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