MEDICARE: STEVEN P JOHNSON PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	071-005462	IL

General Provider Information

NPI Number	:	1194724393
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEVEN P JOHNSON PHD

Provider Business Mailing Address
First Line	:	3405 N KENNICOTT AVE
Second Line	:	SUITE B
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1470
Country	:	US
Telephone Number	:	847-508-2926
Fax Number	:	847-368-0764

Provider Business Practice Location Address
First Line	:	3405 N KENNICOTT AVE
Second Line	:	SUITE B
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-1470
Country	:	US
Telephone Number	:	847-508-2926
Fax Number	:	847-368-0764

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	12/28/2010

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