Provider Demographics
NPI:1982184818
Name:JOHNSON, KAILIE (LSW)
Entity Type:Individual
Prefix:
First Name:KAILIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5471 SCIOTO DARBY RD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-1310
Mailing Address - Country:US
Mailing Address - Phone:614-470-4248
Mailing Address - Fax:
Practice Address - Street 1:5471 SCIOTO DARBY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1310
Practice Address - Country:US
Practice Address - Phone:614-470-4248
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1701763104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker