Provider Demographics
NPI:1619555778
Name:JOHNSON, KAYLA JEAN (MS, LAT, ATC)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:JEAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4547 N KARLOV AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4401
Mailing Address - Country:US
Mailing Address - Phone:773-791-9708
Mailing Address - Fax:
Practice Address - Street 1:190 S PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-3271
Practice Address - Country:US
Practice Address - Phone:630-617-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0960052872255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer