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General NPI Number Information
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NPI Number | 1396934907
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Entity Type | Individual
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Provider Name | ELIZABETH ANNE JOHNSON DTH
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Gender | Female
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Dates
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Enumeration Date | 10/19/2007
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Last Update Date | 10/19/2007
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Provider Practice Location Address
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Address Line | 10912 S HOMAN AVE
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City | CHICAGO
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State | IL
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Zip | 60655-2630
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Country | US
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Telephone | 773-238-8440
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Fax |
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Provider Business Mailing Address
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Address Line | 10912 S. HOMAN AVE.
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City | CHICAGO
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State | IL
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Zip | 60655
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Country | US
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Telephone | 773-238-8440
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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