Provider Demographics
NPI:1215794409
Name:JOHNSON, KAYLA NICOLE
Entity type:Individual
Prefix:MS
First Name:KAYLA
Middle Name:NICOLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1585 N MILWAUKEE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-1359
Mailing Address - Country:US
Mailing Address - Phone:224-430-6907
Mailing Address - Fax:
Practice Address - Street 1:1585 N MILWAUKEE AVE STE 101
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-1359
Practice Address - Country:US
Practice Address - Phone:847-918-7947
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2025-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician