Individual
MILES HAAKON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RBT
Contact information
Practice address
16941 N EAGLE RIVER LOOP RD STE 3, EAGLE RIVER, AK 99577-7824
(907) 726-5330
(907) 726-5330
Mailing address
17636 HILLCREST DR, EAGLE RIVER, AK 99577-9313
(907) 696-8513
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RBT-18-49272
TRICARE
AK
Enumeration date
02/06/2018
Last updated
02/06/2018
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