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General NPI Number Information
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NPI Number | 1750536223
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Entity Type | Individual
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Provider Name | PATRICIA JOHNSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 11/24/2008
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Last Update Date | 11/16/2018
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Provider Practice Location Address
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Address Line | 1122 WESTGATE ST
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City | OAK PARK
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State | IL
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Zip | 60301
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Country | US
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Telephone | 708-228-9492
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Fax |
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Provider Business Mailing Address
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Address Line | 1038 S CUYLER AVE
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City | OAK PARK
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State | IL
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Zip | 60304-2202
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Country | US
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Telephone | 708-228-9492
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071009009
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License Number State | IL
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