Provider Demographics
NPI:1083793632
Name:JOHNSON HEIM, DEBORAH G (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:G
Last Name:JOHNSON HEIM
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 QUINCY AVE
Mailing Address - Street 2:STE 31
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-851-3370
Mailing Address - Fax:630-428-1167
Practice Address - Street 1:1701 QUINCY AVE
Practice Address - Street 2:STE 31
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-851-3370
Practice Address - Fax:630-428-1167
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005244103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical