Healthcare Provider Details

I. General information

NPI: 1851890933
Provider Name (Legal Business Name): KAYTLIN JOHNSON BS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

IV. Provider business mailing address

911 SYCAMORE ST
CINCINNATI OH
45202-1318
US

V. Phone/Fax

Practice location:
  • Phone: 513-618-4232
  • Fax: 513-354-6699
Mailing address:
  • Phone: 513-618-4232
  • Fax: 513-354-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: