Individual
RAE A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
299 SWAN, CENTRALIA, IL 62801
(618) 533-4423
Mailing address
301 S WASHINGTON ST, SALEM, IL 62881-3028
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
04/24/2007
Last updated
07/08/2007
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