Healthcare Provider Details

I. General information

NPI: 1154589778
Provider Name (Legal Business Name): JENNIFER MARIE JOHNSTON M.ED., ED.S, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MARIE KOHL

II. Dates (important events)

Enumeration Date: 05/30/2008
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 CAMINO SERENO AVE
HENDERSON NV
89044-0516
US

IV. Provider business mailing address

2880 BICENTENNIAL PKWY STE 100 #184
HENDERSON NV
89044-4484
US

V. Phone/Fax

Practice location:
  • Phone: 414-614-1940
  • Fax:
Mailing address:
  • Phone: 414-285-5884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4526
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number4526
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: