1487662110 NPI number — MS. JULIE A JOHNSON MA LCPC

Table of content: MS. JULIE A JOHNSON MA LCPC (NPI 1487662110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487662110 NPI number — MS. JULIE A JOHNSON MA LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JULIE
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487662110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2836 W MINNESOTA
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLUE ISLAND
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
773-383-7033
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2656 W. MONTROSE
Provider Second Line Business Practice Location Address:
SUITE 113
Provider Business Practice Location Address City Name:
CHICAGO
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
773-383-7033
Provider Business Practice Location Address Fax Number:
773-920-3316
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  180004543 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com