Individual
MARIE KATHLEEN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BCBA
Contact information
Practice address
10450 72ND AVE, PLEASANT PRAIRIE, WI 53158-2911
(645) 326-2657
Mailing address
1850 NEW ST APT 108, UNION GROVE, WI 53182-1779
(262) 880-5581
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
242-140
WI
Other
Enumeration date
07/23/2018
Last updated
07/23/2018
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