Individual
MR. GERALD BRUCE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4092 W MARBLE WAY, WASILLA, AK 99654-8752
(907) 227-3524
Mailing address
4092 W MARBLE WAY, WASILLA, AK 99654-8752
(907) 715-4403
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1705395
—
AK
05
—
1722922
—
AK
Enumeration date
06/10/2021
Last updated
10/15/2025
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