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NPI Code Detail

MEDICARE: KAREN JOHNSON

MEDICARE: KAREN JOHNSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool PsychologistKU1-01-1916OH

General Provider Information

NPI Number : 1669882908
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN JOHNSON
Provider Business Mailing Address
First Line : 3750 FAR HILLS AVE
Second Line :
City : KETTERING
State : OH
Zip : 45429-2506
Country : US
Telephone Number : 937-499-1651
Fax Number :
Provider Business Practice Location Address
First Line : 3750 FAR HILLS AVE
Second Line :
City : KETTERING
State : OH
Zip : 45429-2506
Country : US
Telephone Number : 937-499-1651
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/07/2014
Last Update Date : 05/07/2014

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