Healthcare Provider Details

I. General information

NPI: 1609429968
Provider Name (Legal Business Name): RHONDA JOHNSON LCMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 N LAKE SHORE DR # 1102547
CHICAGO IL
60611-4546
US

IV. Provider business mailing address

680 N LAKE SHORE DR # 1102547
CHICAGO IL
60611-4546
US

V. Phone/Fax

Practice location:
  • Phone: 773-577-3279
  • Fax:
Mailing address:
  • Phone: 773-577-3279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License NumberNONE
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227020616
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: