Provider Demographics
NPI:1487000378
Name:KIDD-JOHNSON, SHEILA BUNDLEY
Entity Type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:BUNDLEY
Last Name:KIDD-JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8358 S KIMBARK AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-6441
Mailing Address - Country:US
Mailing Address - Phone:773-374-0962
Mailing Address - Fax:
Practice Address - Street 1:8358 S KIMBARK AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-6441
Practice Address - Country:US
Practice Address - Phone:773-374-0962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist