Provider Demographics
NPI:1205198942
Name:JOHNSON, KAI (LCPC)
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6641 SAWGRASS DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-8005
Mailing Address - Country:US
Mailing Address - Phone:779-423-4111
Mailing Address - Fax:
Practice Address - Street 1:6641 SAWGRASS DR
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-8005
Practice Address - Country:US
Practice Address - Phone:779-423-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-08
Last Update Date:2017-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180.008222101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
180008222OtherILLINOIS DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATIONS