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General NPI Number Information
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NPI Number | 1255378881
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Entity Type | Individual
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Provider Name | WILLIAM ELLSWORTH JOHNSON III MSW, LCSW
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Gender | Male
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Dates
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Enumeration Date | 06/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5TH AVE AT ROOSEVELT RD. EDWARD HINES JR. VA HOSPITAL, BLDG 200 ROOM 610
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City | HINES
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State | IL
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Zip | 60141-5122
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Country | US
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Telephone | 708-202-2101
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Fax | 708-202-2346
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Provider Business Mailing Address
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Address Line | 209 S OAK PARK AVE APT. 402
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City | OAK PARK
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State | IL
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Zip | 60302-3262
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Country | US
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Telephone | 708-383-5032
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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 |
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License Number State | IL
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