Provider Demographics
NPI:1982854030
Name:JOHNSON, JOCELYN DENISE
Entity Type:Individual
Prefix:MRS
First Name:JOCELYN
Middle Name:DENISE
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 1:18331 PINE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-4856
Mailing Address - Country:US
Mailing Address - Phone:708-532-0021
Mailing Address - Fax:708-407-8587
Practice Address - Street 1:18331 PINE LAKE DR
Practice Address - Street 2:
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-4856
Practice Address - Country:US
Practice Address - Phone:708-532-0021
Practice Address - Fax:708-407-8587
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-25
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist