Individual
TIFFANY L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10412 W CUSTER AVE, MILWAUKEE, WI 53225-3218
(414) 213-7073
Mailing address
10412 W CUSTER AVE, MILWAUKEE, WI 53225-3218
(414) 213-7073
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
843815038
—
WI
Enumeration date
11/30/2019
Last updated
02/03/2020
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