Provider Demographics
NPI:1518935196
Name:JOHNSON, RHONDA L (PHD)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 E 104TH ST
Mailing Address - Street 2:MS 4017
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-4517
Mailing Address - Country:US
Mailing Address - Phone:913-588-6200
Mailing Address - Fax:913-588-6271
Practice Address - Street 1:3901 RAINBOW BLVD.
Practice Address - Street 2:MS 2028
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66160
Practice Address - Country:US
Practice Address - Phone:913-588-6200
Practice Address - Fax:913-588-6271
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK931103TC0700X
IL071-007508103TC0700X
KS1891103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK53441Medicare PIN
24R601309Medicare PIN