Provider Demographics
NPI:1902208929
Name:JOHNSON, HEATHER A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
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 1:67 MAIN ST
Mailing Address - Street 2:STE 2A
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-8592
Mailing Address - Country:US
Mailing Address - Phone:630-519-1010
Mailing Address - Fax:630-405-7209
Practice Address - Street 1:5 E WASHINGTON ST STE 2D
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-8622
Practice Address - Country:US
Practice Address - Phone:630-631-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490133401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical