Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 071.007472 | IL |
NPI | 1104127448 |
---|---|
Provider Name | Kelli F Johnson |
First Address | Chicago, IL 60640-2389 |
Second Address | Chicago, IL 60611-3591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2010 |
Last Update Date | 03/11/2010 |