Provider Demographics
NPI:1962826206
Name:JOHNSTON, KATHRYN (LAC, PHD)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W LAKEWAY RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6369
Mailing Address - Country:US
Mailing Address - Phone:307-686-2998
Mailing Address - Fax:
Practice Address - Street 1:105 W LAKEWAY RD
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718-6369
Practice Address - Country:US
Practice Address - Phone:307-686-2998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-06
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 2753171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist