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General NPI Number Information
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NPI Number | 1689705204
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Entity Type | Individual
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Provider Name | KATHLEEN H. JOHNSON M.D.
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Gender | Female
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 01/22/2020
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Provider Practice Location Address
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Address Line | 4711 GOLF RD SUITE 1200
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 847-677-0441
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Fax | 847-679-8002
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Provider Business Mailing Address
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Address Line | 4711 GOLF RD SUITE 1200
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City | SKOKIE
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State | IL
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Zip | 60076
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Country | US
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Telephone | 847-677-0441
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Fax | 847-679-8002
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 036-07-8689
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License Number State | IL
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