Provider Demographics
NPI:1699669259
Name:JOHANNES, CARY A (PSYD)
Entity type:Individual
Prefix:DR
First Name:CARY
Middle Name:A
Last Name:JOHANNES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CARY
Other - Middle Name:
Other - Last Name:KNIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15664 LAX CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:KIEL
Mailing Address - State:WI
Mailing Address - Zip Code:53042-3335
Mailing Address - Country:US
Mailing Address - Phone:920-980-8319
Mailing Address - Fax:
Practice Address - Street 1:15664 LAX CHAPEL RD
Practice Address - Street 2:
Practice Address - City:KIEL
Practice Address - State:WI
Practice Address - Zip Code:53042-3335
Practice Address - Country:US
Practice Address - Phone:920-980-8319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2406-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist