Kelly Suzanne Johnson, PSY.D.

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

071-005691 Issued in IL

Practice address

28379 Davis Pkwy
Suite 801 Cantera Lakes Offices-Clarus Center
Warrenville, IL 60555-3032

Phone

(630) 355-3321

Fax

(630) 393-0499

NPI assigned

Feb 20, 2007

Last updated

Sep 11, 2025By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 23, 2020 through Jan 23, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757548800000",
    "number": "1033254164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28379 DAVIS PKWY",
            "address_2": "SUITE 801 CANTERA LAKES OFFICES-CLARUS CENTER",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553032",
            "telephone_number": "630-355-3321",
            "fax_number": "630-393-0499"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28379 DAVIS PKWY",
            "address_2": "SUITE 801 CANTERA LAKES OFFICES-CLARUS CENTER",
            "city": "WARRENVILLE",
            "state": "IL",
            "postal_code": "605553032",
            "telephone_number": "630-355-3321",
            "fax_number": "630-393-0499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "KELLY",
        "middle_name": "SUZANNE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-20",
        "last_updated": "2025-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "IL",
            "license": "071-005691",
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IL",
            "license": "071-005691",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julia Rose Jaudes
• Chandni S Jeshang, APRN, CNP
• Nicole Jimenez
• John C. Choi S.C. (The Eye and Facial Clinic)
• Gwendolyn Angela Johnson, DT
• Hannah C Jones-Lewis, LSW
• Alan Kent Jones
• Jaymie Elizabeth Jorgensen, OT
• Abigail Joyce
• Mason Christian Justice, AS

• Clinical Neuropsychologist in Warrenville, IL
• Providers in Warrenville, IL by specialty
• Clinical Neuropsychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.