Provider Demographics
NPI:1619794807
Name:JOHNSON, JOSIE RAE
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:RAE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WV
Mailing Address - Zip Code:26354-8760
Mailing Address - Country:US
Mailing Address - Phone:304-612-1558
Mailing Address - Fax:
Practice Address - Street 1:134 BIRCH ST
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WV
Practice Address - Zip Code:26354-8760
Practice Address - Country:US
Practice Address - Phone:304-612-1558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency