Provider Demographics
NPI:1679058895
Name:JOHNSON, KATELIN ANN (BCBA)
Entity type:Individual
Prefix:
First Name:KATELIN
Middle Name:ANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 EASTWOOD DR APT 403
Mailing Address - Street 2:
Mailing Address - City:SOUTH BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05403-4521
Mailing Address - Country:US
Mailing Address - Phone:253-509-2639
Mailing Address - Fax:
Practice Address - Street 1:288 GALLISON HILL RD
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602-8352
Practice Address - Country:US
Practice Address - Phone:802-223-6500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT147.0123004106E00000X
VT146.0134138103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst