Individual
JENNIFER S JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
16941 N EAGLE RIVER LOOP RD, EAGLE RIVER, AK 99577-7824
(907) 726-5330
Mailing address
8477 THUNDER MOUNTAIN RD LOT 13, JUNEAU, AK 99801-7518
(907) 209-5556
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
AK
106S00000X
Behavior Technician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
106S00000X
TRICARE
AK
Enumeration date
05/01/2018
Last updated
05/01/2018
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