Provider Demographics
NPI:1124233051
Name:JOHNSON, CAROL K (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 HARGER RD
Mailing Address - Street 2:SUITE505
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1805
Mailing Address - Country:US
Mailing Address - Phone:630-571-5750
Mailing Address - Fax:630-571-5751
Practice Address - Street 1:1200 HARGER RD
Practice Address - Street 2:SUITE505
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1805
Practice Address - Country:US
Practice Address - Phone:630-571-5750
Practice Address - Fax:630-571-5751
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical