Johnson, Kenneth Roger

Johnson, Kenneth Roger is an sole proprietor health care provider with primary practice located at 5757 Monclova Rd Suite 16C, Maumee OH 43537-1863. He recently has 7 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Clinical Child & Adolescent, Behavioral Health & Social Service Providers / Family, Behavioral Health & Social Service Providers / Health Service, Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities, Behavioral Health & Social Service Providers / Psychologist, Behavioral Health & Social Service Providers / School. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Johnson, Kenneth Roger can be contacted via phone (419) 893-0300.

Contact Information

Primary practice address
5757 Monclova Rd Suite 16C Maumee OH 43537-1863
Phone: (419) 893-0300
Fax: (419) 891-0356
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X 1023 Ohio
Behavioral Health & Social Service Providers / Clinical Child & Adolescent 103TC2200X 1023 Ohio
Behavioral Health & Social Service Providers / Family 103TF0000X 1023 Ohio
Behavioral Health & Social Service Providers / Health Service 103TH0100X 1023 Ohio
Behavioral Health & Social Service Providers / Mental Retardation & Developmental Disabilities 103TM1800X 1023 Ohio
Behavioral Health & Social Service Providers / Psychologist 103T00000X 1023 Ohio
Behavioral Health & Social Service Providers / School 103TS0200X 1023 Ohio

Profile Details

NPI number 1336269356
LBN Legal business name Johnson, Kenneth Roger
Credentials Master of Education (MED)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 31st, 2007
Last updated Jul 8th, 2007 - about 17 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1336269356 NPPES
Ohio MEDICAID 0253854

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