Healthcare Provider Details

I. General information

NPI: 1396542197
Provider Name (Legal Business Name): LAVANGELA JOHNSON TURNER LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAVANGELA JOHNSON LSW

II. Dates (important events)

Enumeration Date: 02/27/2025
Last Update Date: 02/28/2025
Certification Date: 02/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 LAKE ST STE 503
OAK PARK IL
60301-1135
US

IV. Provider business mailing address

1010 LAKE ST STE 503
OAK PARK IL
60301-1135
US

V. Phone/Fax

Practice location:
  • Phone: 708-888-0491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number150.112747
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: