Most Relevant Information
Provider Data
| NPI Number: | 1003586223 |
| Provider Name: | TARREN NICOLE JOHNSEN |
| Entity Type: | Individual |
| Taxonomy Code: | 106S00000X |
| Specialty: | Behavior Technician |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/18/2021 |
| Last Updated: | 09/18/2021 |
Provider Practice Location
2785 EAGLE DR APT D202
AMMON
ID
834065725
Practice Location Phone/Fax
| Phone: | 2084192695 |
| Fax: |
Provider Mailing Location
2785 EAGLE DR APT D202
AMMON
ID
834065725
Provider Mailing Phone/Fax
| Phone: | 2084192695 |
| Fax: |