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General NPI Number Information
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NPI Number | 1427174994
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Entity Type | Individual
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Provider Name | SHEILA BLOSSOM JOHNSON LCPC
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 1497 N LA FOX ST
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City | SOUTH ELGIN
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State | IL
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Zip | 60177-1227
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Country | US
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Telephone | 847-903-1156
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Fax | 847-697-4717
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Provider Business Mailing Address
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Address Line | 1561 FRANCIS DR
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City | PINGREE GROVE
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State | IL
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Zip | 60140-5411
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Country | US
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Telephone | 847-903-1156
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Fax | 847-697-4717
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-003949
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License Number State | IL
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