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General NPI Number Information
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NPI Number | 1922435445
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Entity Type | Individual
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Provider Name | GLADYS M JOHNSON M.A. LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/29/2013
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Last Update Date | 09/29/2013
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Provider Practice Location Address
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Address Line | 8319 S CLYDE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1841
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Country | US
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Telephone | 773-768-8914
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Fax | 773-768-2016
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Provider Business Mailing Address
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Address Line | 8319 S CLYDE AVE
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City | CHICAGO
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State | IL
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Zip | 60617-1841
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Country | US
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Telephone | 773-768-8914
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Fax | 773-768-2016
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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 | 149007224
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License Number State | IL
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