Provider Demographics
NPI:1073824066
Name:JOHNSON, MARGARET MARY
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:MARY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6933 EXNER RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-3693
Mailing Address - Country:US
Mailing Address - Phone:630-963-2552
Mailing Address - Fax:630-963-2569
Practice Address - Street 1:9649 W 55TH ST
Practice Address - Street 2:
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-3632
Practice Address - Country:US
Practice Address - Phone:708-352-3580
Practice Address - Fax:708-352-9728
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146002561235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist