Provider Demographics
NPI:1891058293
Name:JOHNSON, JENNA LEE
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 E CHICAGO AVE
Mailing Address - Street 2:SUITE 151
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5526
Mailing Address - Country:US
Mailing Address - Phone:630-305-4196
Mailing Address - Fax:630-305-4785
Practice Address - Street 1:1001 E CHICAGO AVE
Practice Address - Street 2:SUITE 151
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5526
Practice Address - Country:US
Practice Address - Phone:630-305-4196
Practice Address - Fax:630-305-4785
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2012-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst