Healthcare Provider Details

I. General information

NPI: 1164734786
Provider Name (Legal Business Name): JP ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 07/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 NORTH AVE
OAK PARK IL
60302-1005
US

IV. Provider business mailing address

6601 NORTH AVE
OAK PARK IL
60302-1005
US

V. Phone/Fax

Practice location:
  • Phone: 708-524-1379
  • Fax: 708-406-1577
Mailing address:
  • Phone: 708-524-1379
  • Fax: 708-406-1577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAINA JOHNSON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 708-524-1379