Provider Demographics
NPI:1306572573
Name:JOHNSON, KAYLA (BS, SUDPT)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:BS, SUDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:910 N WASHINGTON ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99201-2260
Mailing Address - Country:US
Mailing Address - Phone:509-327-9831
Mailing Address - Fax:
Practice Address - Street 1:910 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2202
Practice Address - Country:US
Practice Address - Phone:509-327-9831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
WACO61385776101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician