Individual
KENYANA T JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DEVELOPMENTAL THERAP
Contact information
Practice address
12620 S WOOD ST, CALUMET PARK, IL 60827-5916
(708) 955-4509
Mailing address
12620 S WOOD ST, CALUMET PARK, IL 60827-5916
(708) 955-4509
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
IL
Other
Enumeration date
04/06/2010
Last updated
04/06/2010
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