Individual
MR. KENNETH ROGER JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.ED
Contact information
Practice address
5757 MONCLOVA RD, SUITE 16C, MAUMEE, OH 43537-1863
(419) 893-0300
(419) 891-0356
Mailing address
2539 SHETLAND RD, TOLEDO, OH 43617-1635
(419) 841-4108
(419) 891-0356
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
1023
OH
103TC0700X
Clinical Psychologist
1023
OH
103TC2200X
Clinical Child & Adolescent Psychologist
1023
OH
103TF0000X
Family Psychologist
1023
OH
103TH0100X
Health Service Psychologist
1023
OH
103TM1800X
Intellectual & Developmental Disabilities Psychologist
1023
OH
103TS0200X
School Psychologist
Primary
1023
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0253854
—
OH
Enumeration date
03/31/2007
Last updated
09/11/2025
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