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NPI Code Detail

MEDICARE: KATHERINE M JOHNSON LCSW

MEDICARE: KATHERINE M 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
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker149021455IL

General Provider Information

NPI Number : 1750939476
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE M JOHNSON LCSW
Provider Business Mailing Address
First Line : 6821 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60621-1833
Country : US
Telephone Number : 773-651-3629
Fax Number :
Provider Business Practice Location Address
First Line : 228 E LAKE ST
Second Line :
City : ADDISON
State : IL
Zip : 60101-2889
Country : US
Telephone Number : 630-835-1430
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2019
Last Update Date : 05/08/2023

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