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NPI Code Detail

MEDICARE: MR. JENNIFER S JOHNSON LCSW

MEDICARE: MR. JENNIFER S JOHNSON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerIL

General Provider Information

NPI Number : 1083665368
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JENNIFER S JOHNSON LCSW
Provider Business Mailing Address
First Line : 1285 FRANCISCAN DR
Second Line :
City : LITCHFIELD
State : IL
Zip : 62056-1778
Country : US
Telephone Number : 217-324-6127
Fax Number : 217-324-5959
Provider Business Practice Location Address
First Line : 1285 FRANCISCAN DR
Second Line :
City : LITCHFIELD
State : IL
Zip : 62056-1778
Country : US
Telephone Number : 217-324-6127
Fax Number : 217-324-5959
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2006
Last Update Date : 04/18/2008

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