Provider Demographics
NPI:1396540514
Name:JOHNSON, KATHERINE (MED)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:KAT
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:683 FALLOWFIELD RD
Mailing Address - Street 2:
Mailing Address - City:ATGLEN
Mailing Address - State:PA
Mailing Address - Zip Code:19310-9690
Mailing Address - Country:US
Mailing Address - Phone:610-961-1358
Mailing Address - Fax:
Practice Address - Street 1:701 E BALTIMORE PIKE STE C
Practice Address - Street 2:
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348-2400
Practice Address - Country:US
Practice Address - Phone:724-578-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-13
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA7312672101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool