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General NPI Number Information
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NPI Number | 1730074428
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Entity Type | Individual
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Provider Name | JESECA ARLEASE JOHNSON
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Gender | Female
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Dates
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Enumeration Date | 06/11/2025
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 611 W JEFFERSON ST STE 201
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City | SHOREWOOD
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State | IL
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Zip | 60404-3772
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Country | US
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Telephone | 630-281-2496
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Fax | 630-839-9138
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Provider Business Mailing Address
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Address Line | 19030 WILLOW AVE
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City | COUNTRY CLUB HILLS
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State | IL
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Zip | 60478-5741
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Country | US
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Telephone | 708-310-1174
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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