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General NPI Number Information
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NPI Number | 1023898004
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Entity Type | Individual
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Provider Name | KEONA S JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 10/05/2023
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Last Update Date | 10/01/2024
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Provider Practice Location Address
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Address Line | 1806 WOODFIELD DR STE 105
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City | SAVOY
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State | IL
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Zip | 61874-9505
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Country | US
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Telephone | 217-766-0258
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Fax |
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Provider Business Mailing Address
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Address Line | 2501 CHATHAM RD STE 5633
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City | SPRINGFIELD
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State | IL
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Zip | 62704-4188
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Country | US
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Telephone | 217-364-8338
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.025789
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License Number State | IL
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