MEDICARE: MRS. VETTA ANNE LOVE-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	149015244	IL

General Provider Information

NPI Number	:	1578994224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VETTA ANNE LOVE-JOHNSON LCSW

Provider Business Mailing Address
First Line	:	4533 177TH ST
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-4506
Country	:	US
Telephone Number	:	708-206-0138
Fax Number	:

Provider Business Practice Location Address
First Line	:	4533 177TH ST
Second Line	:
City	:	COUNTRY CLUB HILLS
State	:	IL
Zip	:	60478-4506
Country	:	US
Telephone Number	:	708-206-0138
Fax Number	:

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

Provider Enumeration Date	:	12/06/2013
Last Update Date	:	12/06/2013

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