Individual
MISS ANGIE JOHNSON ISAAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ED.S.
Contact information
Practice address
2013 N 36TH ST, PHOENIX, AZ 85008-3026
(602) 381-6100
Mailing address
1869 W MANOR ST, CHANDLER, AZ 85224-5108
(480) 786-0611
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
076869
AHCCCS PROVIDER NUMBER
AZ
Enumeration date
02/06/2007
Last updated
07/08/2007
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