MEDICARE: DR. KRISTINE L JOHNSON PHD

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	103T00000X	Psychologist	1118	KS

General Provider Information

NPI Number	:	1700826195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTINE L JOHNSON PHD

Provider Business Mailing Address
First Line	:	1105 JANA CT
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4417
Country	:	US
Telephone Number	:	785-218-4426
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 WAKARUSA DR, BLDG E
Second Line	:	SUITE E-2
City	:	LAWRENCE
State	:	KS
Zip	:	66049-4722
Country	:	US
Telephone Number	:	785-434-3479
Fax Number	:	785-384-5618

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	02/20/2024

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