Individual
TATIYANA SHAUNTIA RENAY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1095 HARCOURT RD, MOUNT VERNON, OH 43050-4476
(740) 848-1010
Mailing address
560 ARNOLD AVE, MANSFIELD, OH 44903-2148
(330) 275-6594
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
06/01/2023
Last updated
06/01/2023
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