Most Relevant Information
Provider Data
| NPI Number: | 1003462201 |
| Provider Name: | MCKENZIE JOHNSON |
| Entity Type: | Individual |
| Taxonomy Code: | 103K00000X |
| Specialty: | Behavior Analyst |
| License Number: | 1-22-58551 |
Most Important Dates
| Enumeration Date: | 08/13/2019 |
| Last Updated: | 04/17/2023 |
Provider Practice Location
1547 30TH AVE S
MOORHEAD
MN
565605149
Practice Location Phone/Fax
| Phone: | 2182874338 |
| Fax: |
Provider Mailing Location
1547 30TH AVE S
MOORHEAD
MN
565605149
Provider Mailing Phone/Fax
| Phone: | 2182874338 |
| Fax: |