Healthcare Provider Details

I. General information

NPI: 1215794409
Provider Name (Legal Business Name): MS. KAYLA NICOLE JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13200 GLOBE DR STE 211
MT PLEASANT WI
53177-1615
US

IV. Provider business mailing address

13200 GLOBE DR STE 211
MT PLEASANT WI
53177-1615
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-5660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: