Individual
KEVIN HERBERT JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CPSSS
Contact information
Practice address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 322-3222
Mailing address
344 E 100 S, SALT LAKE CITY, UT 84111-1700
(801) 322-3222
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
809
UT
Other
Enumeration date
09/07/2018
Last updated
09/07/2018
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