Provider Demographics
NPI:1194134379
Name:JOHNSON, ULANDA
Entity type:Individual
Prefix:
First Name:ULANDA
Middle Name:
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 1:1917 KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:PA
Mailing Address - Zip Code:15068-4224
Mailing Address - Country:US
Mailing Address - Phone:724-335-1132
Mailing Address - Fax:
Practice Address - Street 1:1917 KENNETH AVE
Practice Address - Street 2:
Practice Address - City:ARNOLD
Practice Address - State:PA
Practice Address - Zip Code:15068-4224
Practice Address - Country:US
Practice Address - Phone:724-980-1237
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst