Healthcare Provider Details

I. General information

NPI: 1740753722
Provider Name (Legal Business Name): ANTHONY ROBERT JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 ROHLWING RD STE A
ROLLING MEADOWS IL
60008-1474
US

IV. Provider business mailing address

2201 RENAISSANCE BLVD FL 3
KING OF PRUSSIA PA
19406-2709
US

V. Phone/Fax

Practice location:
  • Phone: 800-732-6837
  • Fax:
Mailing address:
  • Phone: 610-908-5782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: