=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528922127
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER JOHNSTON BA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/10/2025
-----------------------------------------------------
Last Update Date | 12/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1414 MAIN ST
-----------------------------------------------------
City | MELROSE PARK
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60160-3902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-681-0073
-----------------------------------------------------
Fax | 708-681-3958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 ROB ROY LN APT B
-----------------------------------------------------
City | PROSPECT HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60070-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-681-4357
-----------------------------------------------------
Fax | 708-681-2285
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------