Provider Demographics
NPI:1669182705
Name:BARLOWJOHNSON, KENDRA
Entity type:Individual
Prefix:MS
First Name:KENDRA
Middle Name:
Last Name:BARLOWJOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 E MADISON ST.
Mailing Address - Street 2:126
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62701
Mailing Address - Country:US
Mailing Address - Phone:217-220-4635
Mailing Address - Fax:
Practice Address - Street 1:1405 N 4TH ST APT 1
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-2576
Practice Address - Country:US
Practice Address - Phone:217-953-5076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-30
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374K00000X, 174400000X, 390200000X, 251E00000X
IL376K00000X
WA914078101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No374K00000XNursing Service Related ProvidersReligious Nonmedical Practitioner
No376K00000XNursing Service Related ProvidersNurse's Aide
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No251E00000XAgenciesHome Health