Organization
KIRBY JOHNSON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRBY JOHNSON (BEHAVIOR ANALYST)
(309) 360-6268
Entity
Organization
Contact information
Practice address
3807 N LEAVITT ST APT 2, CHICAGO, IL 60618-3825
(309) 360-6268
Mailing address
3807 N LEAVITT ST APT 2, CHICAGO, IL 60618-3825
(309) 360-6268
Taxonomy
Speciality
Code
Description
License number
State
320900000X
Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
Primary
—
—
Other
Enumeration date
03/11/2015
Last updated
03/11/2015
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