Individual
KEYONTA LATRISE JOHNSON- SIMS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1871 WALLACE LAKE RD, WEST BEND, WI 53090-9074
(414) 915-1531
Mailing address
2144 N 33RD ST, MILWAUKEE, WI 53208-1426
(414) 915-1531
Taxonomy
Speciality
Code
Description
License number
State
103TA0700X
Adult Development & Aging Psychologist
Primary
0020200
WI
Other
Enumeration date
05/21/2025
Last updated
05/21/2025
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