Healthcare Provider Details

I. General information

NPI: 1508779588
Provider Name (Legal Business Name): TAYLOR BREEZE JOHNSON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 PAWLAK PKWY
NEW LENOX IL
60451-9401
US

IV. Provider business mailing address

1609 SAWGRASS LN
BEECHER IL
60401-3377
US

V. Phone/Fax

Practice location:
  • Phone: 815-215-3300
  • Fax: 815-215-3400
Mailing address:
  • Phone: 815-215-3300
  • Fax: 815-215-3400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.0211491
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: