Provider Demographics
NPI:1053840207
Name:STROKOFF, JOHANNA (PHD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:
Last Name:STROKOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E MONROE ST STE 3800
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-6030
Mailing Address - Country:US
Mailing Address - Phone:872-529-0847
Mailing Address - Fax:
Practice Address - Street 1:55 E MONROE ST STE 3800
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60603-6030
Practice Address - Country:US
Practice Address - Phone:872-529-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-09
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.009416103TC0700X
IL071009416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
82-1811325OtherOUT-OF-NETWORK