Provider Demographics
NPI:1982672424
Name:JOHNSON, REGINA (ATCL)
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:ATCL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 NORBERT DR
Mailing Address - Street 2:
Mailing Address - City:HAWTHORN WOODS
Mailing Address - State:IL
Mailing Address - Zip Code:60047-9145
Mailing Address - Country:US
Mailing Address - Phone:847-540-0404
Mailing Address - Fax:
Practice Address - Street 1:10 NORBERT DR
Practice Address - Street 2:
Practice Address - City:HAWTHORN WOODS
Practice Address - State:IL
Practice Address - Zip Code:60047-9145
Practice Address - Country:US
Practice Address - Phone:847-540-0404
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer