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General NPI Number Information
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NPI Number | 1417276031
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Entity Type | Individual
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Provider Name | ERIC T. JOHNSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 05/21/2010
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Last Update Date | 02/22/2016
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Provider Practice Location Address
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Address Line | 710 N WEBB AVE
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City | REEDSBURG
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State | WI
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Zip | 53959-1149
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Country | US
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Telephone | 608-524-5151
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Fax | 608-524-5353
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Provider Business Mailing Address
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Address Line | 2334 W LAWRENCE AVE SUITE 204
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City | CHICAGO
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State | IL
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Zip | 60625-1948
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Country | US
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Telephone | 773-456-9379
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Fax | 443-460-9379
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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 | 149.011832
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 8441-123
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License Number State | WI
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