Healthcare Provider Details

I. General information

NPI: 1164301073
Provider Name (Legal Business Name): NA'KIYA JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 08/27/2025
Certification Date: 08/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 185TH ST STE AB
TINLEY PARK IL
60487-9232
US

IV. Provider business mailing address

8201 CASS AVE
DARIEN IL
60561-5314
US

V. Phone/Fax

Practice location:
  • Phone: 708-580-0440
  • Fax:
Mailing address:
  • Phone: 630-590-5571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: