Individual
LA WANDA JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PPS
Contact information
Practice address
962 TRESTLE GLEN WAY, SACRAMENTO, CA 95831-2737
(619) 665-1459
Mailing address
962 TRESTLE GLEN WAY, SACRAMENTO, CA 95831-2737
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
150135700
CA
Other
Enumeration date
03/18/2020
Last updated
03/18/2020
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