Provider Demographics
NPI:1609482173
Name:TAYLOR-JOHNSON, KAITLYN ANN (LSW)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:ANN
Last Name:TAYLOR-JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:A
Other - Last Name:CASE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2125 S NEIL ST
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-7266
Mailing Address - Country:US
Mailing Address - Phone:217-352-0200
Mailing Address - Fax:217-607-1139
Practice Address - Street 1:116 S LOMBARD ST
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9202
Practice Address - Country:US
Practice Address - Phone:217-352-0200
Practice Address - Fax:217-607-1139
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.111942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker