Provider Demographics
NPI:1821655184
Name:JOHNSON, KAYLEE (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5801 WASHINGTON AVE STE 201C
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4057
Mailing Address - Country:US
Mailing Address - Phone:262-909-5674
Mailing Address - Fax:
Practice Address - Street 1:5801 WASHINGTON AVE STE 201C
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53406-4057
Practice Address - Country:US
Practice Address - Phone:262-909-5674
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9664-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1821655184Medicaid