Provider Demographics
NPI:1699837310
Name:JOHNSON, KARIN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KARIN
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:KARIN
Other - Middle Name:M
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1110 N WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2767
Mailing Address - Country:US
Mailing Address - Phone:630-369-3690
Mailing Address - Fax:630-801-1090
Practice Address - Street 1:1110 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2767
Practice Address - Country:US
Practice Address - Phone:630-369-3690
Practice Address - Fax:630-801-1090
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2225975OtherBCBS
IL364365810OtherTAX ID
IL364365810OtherTAX ID