Provider Demographics
NPI:1629253802
Name:JOHNSON, KIMBERLY E (PSYD, HSPP, APIT)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD, HSPP, APIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10761 CHESAPEAKE DR N
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46236-8964
Mailing Address - Country:US
Mailing Address - Phone:317-260-8928
Mailing Address - Fax:317-293-1241
Practice Address - Street 1:10761 CHESAPEAKE DR N
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46236-8964
Practice Address - Country:US
Practice Address - Phone:317-748-4520
Practice Address - Fax:317-293-1241
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-07
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042216A103TC0700X
IN20042216103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical