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General NPI Number Information
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NPI Number | 1700798709
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Entity Type | Individual
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Provider Name | MRS. KACIE PEARL JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 640 E SAINT CHARLES RD STE 202
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City | CAROL STREAM
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State | IL
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Zip | 60188-2600
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Country | US
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Telephone | 708-680-7486
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Fax |
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Provider Business Mailing Address
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Address Line | 9118 LINCOLN AVE APT 1
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City | BROOKFIELD
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State | IL
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Zip | 60513-2915
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Country | US
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Telephone |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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