Provider Demographics
NPI:1487819892
Name:JOHNSON, LAUREN LEANN
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LEANN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:LEANN
Other - Last Name:RANEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2425 W PRATT BLVD
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60645-4665
Mailing Address - Country:US
Mailing Address - Phone:773-338-5437
Mailing Address - Fax:
Practice Address - Street 1:2425 W PRATT BLVD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60645-4665
Practice Address - Country:US
Practice Address - Phone:773-338-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath