Healthcare Provider Details

I. General information

NPI: 1447183488
Provider Name (Legal Business Name): KENYA C JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N PATRICK BLVD
BROOKFIELD WI
53045-5883
US

IV. Provider business mailing address

5935 N 71ST ST
MILWAUKEE WI
53218-1821
US

V. Phone/Fax

Practice location:
  • Phone: 414-975-9263
  • Fax:
Mailing address:
  • Phone: 414-975-9263
  • Fax: 414-975-9263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: