Provider Demographics
NPI:1477562866
Name:JOHNSON-DECHOW, DENISE M (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:JOHNSON-DECHOW
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 N KELLOGG ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-2875
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:834 NORTH SEMINARY STREET
Practice Address - Street 2:SUITE 405
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401
Practice Address - Country:US
Practice Address - Phone:309-344-9444
Practice Address - Fax:309-717-0124
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0360963652084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036096365Medicaid
G57302Medicare UPIN
IL036096365Medicaid