Healthcare Provider Details

I. General information

NPI: 1528247707
Provider Name (Legal Business Name): VANESSA JEAN KAHEN JOHNSON PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 S VALLEY RD SUITE 201
PAOLI PA
19301-1450
US

IV. Provider business mailing address

900 TWYCKENHAM RD
MEDIA PA
19063-1636
US

V. Phone/Fax

Practice location:
  • Phone: 610-342-7098
  • Fax:
Mailing address:
  • Phone: 610-342-7098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS015048
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: