Provider Demographics
NPI:1598362667
Name:JOHNSON, KELSEY ALAINA
Entity Type:Individual
Prefix:MISS
First Name:KELSEY
Middle Name:ALAINA
Last Name: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 1:80 N LIMERICK RD
Mailing Address - Street 2:
Mailing Address - City:LIMERICK
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1782
Mailing Address - Country:US
Mailing Address - Phone:484-686-3956
Mailing Address - Fax:
Practice Address - Street 1:1 IRON BRIDGE DR
Practice Address - Street 2:
Practice Address - City:COLLEGEVILLE
Practice Address - State:PA
Practice Address - Zip Code:19426-2058
Practice Address - Country:US
Practice Address - Phone:484-975-0675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-02
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician