Provider Demographics
NPI:1487285862
Name:JOHNSON, KRISTEN KAYE
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:KAYE
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 1:4180 COOK AVE
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46062-6172
Mailing Address - Country:US
Mailing Address - Phone:317-965-3837
Mailing Address - Fax:
Practice Address - Street 1:125 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:KOKOMO
Practice Address - State:IN
Practice Address - Zip Code:46901-4554
Practice Address - Country:US
Practice Address - Phone:765-419-0411
Practice Address - Fax:800-727-9914
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst