MEDICARE: KIRBY JOHNSON

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	103K00000X	Behavior Analyst	473238828	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922491398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRBY JOHNSON

Provider Business Mailing Address
First Line	:	3807 N LEAVITT ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3825
Country	:	US
Telephone Number	:	309-360-6268
Fax Number	:

Provider Business Practice Location Address
First Line	:	3807 N LEAVITT ST APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-3825
Country	:	US
Telephone Number	:	309-360-6268
Fax Number	:

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

Provider Enumeration Date	:	03/10/2015
Last Update Date	:	03/10/2015

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Directions to “ KIRBY JOHNSON ” Practice Location

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