Provider Demographics
NPI:1053154377
Name:JOHNSON, HAELI JO
Entity type:Individual
Prefix:
First Name:HAELI
Middle Name:JO
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 1:3131 FERRY AVE APT A103
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-6581
Mailing Address - Country:US
Mailing Address - Phone:509-540-8945
Mailing Address - Fax:
Practice Address - Street 1:3131 FERRY AVE APT A103
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6581
Practice Address - Country:US
Practice Address - Phone:509-540-8945
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst