Provider Demographics
NPI:1992434690
Name:JOHNSON, KALEN DIANNE
Entity type:Individual
Prefix:MS
First Name:KALEN
Middle Name:DIANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:KATIE
Other - Middle Name:DIANNE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2868 MAHAN DR
Mailing Address - Street 2:UNIT 25,26,27
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308
Mailing Address - Country:US
Mailing Address - Phone:850-391-6060
Mailing Address - Fax:
Practice Address - Street 1:2868 MAHAN DR
Practice Address - Street 2:UNIT 25,26,27
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308
Practice Address - Country:US
Practice Address - Phone:850-391-6060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician