Individual
KIRBY JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
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
103K00000X
Behavior Analyst
Primary
473238828
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
473238828
—
IL
Enumeration date
03/10/2015
Last updated
03/10/2015
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