Provider Demographics
NPI:1376272526
Name:JOHNSON, KAYLA MARIE (MA, BCBA)
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W WINNECONNE AVE
Mailing Address - Street 2:
Mailing Address - City:NEENAH
Mailing Address - State:WI
Mailing Address - Zip Code:54956-2157
Mailing Address - Country:US
Mailing Address - Phone:920-381-4133
Mailing Address - Fax:920-325-0022
Practice Address - Street 1:1276 W WINNECONNE AVE
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-2157
Practice Address - Country:US
Practice Address - Phone:920-381-4133
Practice Address - Fax:920-325-0022
Is Sole Proprietor?:No
Enumeration Date:2022-06-05
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI106S00000X
WI1398-140103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician