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General NPI Number Information
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NPI Number | 1619555778
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Entity Type | Individual
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Provider Name | KAYLA JEAN JOHNSON MS, LAT, ATC
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Gender | Female
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Dates
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Enumeration Date | 03/31/2021
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Last Update Date | 02/01/2023
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Provider Practice Location Address
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Address Line | 190 S PROSPECT AVE
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City | ELMHURST
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State | IL
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Zip | 60126-3271
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Country | US
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Telephone | 630-617-3400
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Fax |
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Provider Business Mailing Address
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Address Line | 4547 N KARLOV AVE
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City | CHICAGO
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State | IL
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Zip | 60630-4401
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Country | US
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Telephone | 773-791-9708
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096005287
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License Number State | IL
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