Healthcare Provider Details

I. General information

NPI: 1063957876
Provider Name (Legal Business Name): RUTH LYNN JOHNSON LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2017
Last Update Date: 12/27/2022
Certification Date: 12/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 WALNUT AVE
WHEELING IL
60090-5036
US

IV. Provider business mailing address

388 WALNUT AVE
WHEELING IL
60090-5036
US

V. Phone/Fax

Practice location:
  • Phone: 773-720-4029
  • Fax:
Mailing address:
  • Phone: 773-720-4029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number208000450
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number180.014815
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: