Active NPI
Kenneth Roger Johnson, M.ED
- School Psychologist
- Maumee, OH
National Provider Identifier
1336269356
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- License
- 1023
- Practice address
- 5757 Monclova Rd
Suite 16C
Maumee, OH 43537-1863 - Phone
- (419) 893-0300
- Fax
- (419) 891-0356
- NPI assigned
- Mar 31, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 7
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 1023 | OH | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1023 | OH | |
| Family Psychologist | 103TF0000X | 1023 | OH | |
| Health Service Psychologist | 103TH0100X | 1023 | OH | |
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | 1023 | OH | |
| Psychologist | 103T00000X | 1023 | OH | |
| School Psychologist | 103TS0200X | 1023 | OH | Primary |
Addresses
Primary practice location
5757 Monclova Rd
Suite 16C
Maumee, OH 43537-1863
Mailing address
2539 Shetland Rd
Toledo, OH 43617-1635
Phone (419) 841-4108
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0253854 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1023 | OH | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175299200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1757548800000",
"number": "1336269356",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2539 SHETLAND RD",
"city": "TOLEDO",
"state": "OH",
"postal_code": "436171635",
"telephone_number": "419-841-4108",
"fax_number": "419-891-0356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5757 MONCLOVA RD",
"address_2": "SUITE 16C",
"city": "MAUMEE",
"state": "OH",
"postal_code": "435371863",
"telephone_number": "419-893-0300",
"fax_number": "419-891-0356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "KENNETH",
"middle_name": "ROGER",
"name_prefix": "Mr.",
"credential": "M.ED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-31",
"last_updated": "2025-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103TF0000X",
"taxonomy_group": "",
"desc": "Psychologist, Family",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103TH0100X",
"taxonomy_group": "",
"desc": "Psychologist, Health Service",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "OH",
"license": "1023",
"primary": false
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "OH",
"license": "1023",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0253854",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Maumee, OH
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.