MEDICARE: ANITA L JOHNSON LCSW

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	1041C0700X	Clinical Social Worker	149.028129	IL

General Provider Information

NPI Number	:	1215667464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANITA L JOHNSON LCSW

Provider Business Mailing Address
First Line	:	20015 S LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	708-275-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	20015 S LAGRANGE RD
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-3104
Country	:	US
Telephone Number	:	708-971-0224
Fax Number	:

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

Provider Enumeration Date	:	06/11/2022
Last Update Date	:	01/10/2025

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