Provider Demographics
NPI:1851121479
Name:JOHNSON, REBEKAH WHITNEY (MT-BC)
Entity type:Individual
Prefix:MRS
First Name:REBEKAH
Middle Name:WHITNEY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1995 E COALTON RD APT 45-101
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR
Mailing Address - State:CO
Mailing Address - Zip Code:80027-4492
Mailing Address - Country:US
Mailing Address - Phone:719-469-5583
Mailing Address - Fax:
Practice Address - Street 1:1995 E COALTON RD APT 45-101
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:CO
Practice Address - Zip Code:80027-4492
Practice Address - Country:US
Practice Address - Phone:719-469-5583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO15823225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist