Provider Demographics
NPI:1851327779
Name:JOHNSON, TAMMY MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIE
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 1:12310 HERITAGE MEADOWS DR
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60585-6159
Mailing Address - Country:US
Mailing Address - Phone:815-685-7231
Mailing Address - Fax:815-254-0898
Practice Address - Street 1:12310 HERITAGE MEADOWS DR
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60585-6159
Practice Address - Country:US
Practice Address - Phone:815-685-7231
Practice Address - Fax:815-254-0898
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
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