MEDICARE: MRS. VANIA JOHNSON

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	149.030768	IL

General Provider Information

NPI Number	:	1669313490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANIA JOHNSON

Provider Business Mailing Address
First Line	:	1130 S CANAL ST STE 1143
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5058
Country	:	US
Telephone Number	:	312-426-2327
Fax Number	:

Provider Business Practice Location Address
First Line	:	1130 S CANAL ST STE 1143
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-5058
Country	:	US
Telephone Number	:	312-870-0297
Fax Number	:

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

Provider Enumeration Date	:	04/04/2026
Last Update Date	:	05/21/2026

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Directions to “ MRS. VANIA JOHNSON ” Practice Location

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