MEDICARE: DR. KARIN M JOHNSON PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071005988	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2225975	OTHER	IL	BCBS
2	364365810	OTHER	IL	TAX ID

General Provider Information

NPI Number	:	1699837310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARIN M JOHNSON PSYD

Provider Business Mailing Address
First Line	:	1110 N WASHINGTON ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2767
Country	:	US
Telephone Number	:	630-369-3690
Fax Number	:	630-801-1090

Provider Business Practice Location Address
First Line	:	1110 N WASHINGTON ST
Second Line	:
City	:	NAPERVILLE
State	:	IL
Zip	:	60563-2767
Country	:	US
Telephone Number	:	630-369-3690
Fax Number	:	630-801-1090

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2006
Last Update Date	:	10/12/2023

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