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General NPI Number Information
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NPI Number | 1699549865
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Entity Type | Individual
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Provider Name | KAYTLYN MARIE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 11/08/2023
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Last Update Date | 11/08/2023
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Provider Practice Location Address
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Address Line | 200 E 5TH AVE STE 109
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City | NAPERVILLE
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State | IL
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Zip | 60563-3173
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Country | US
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Telephone | 312-646-0238
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Fax |
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Provider Business Mailing Address
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Address Line | 2917 WILLIAMS DR
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City | WOODRIDGE
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State | IL
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Zip | 60517-1921
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Country | US
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Telephone | 224-805-7004
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 178019515
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License Number State | IL
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