Provider Demographics
NPI:1982267829
Name:JOHNSON, VERONICA G
Entity type:Individual
Prefix:
First Name:VERONICA
Middle Name:G
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 1:7102 S CASE MOUNTAIN CV
Mailing Address - Street 2:
Mailing Address - City:WEST JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84081-3996
Mailing Address - Country:US
Mailing Address - Phone:801-598-1952
Mailing Address - Fax:
Practice Address - Street 1:7102 S CASE MOUNTAIN CV
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84081-3996
Practice Address - Country:US
Practice Address - Phone:801-598-1952
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician