| NPI | 1588295083 |
|---|---|
| Former Name | KAITLYNN JOHNSON |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: IL 178.015508) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178.015508) |
| Enumeration Date | 2020-02-03 |
| Last Update Date | 2024-11-05 |