Provider Demographics
NPI:1003665720
Name:JOHNSON, JOYCE ARLENE
Entity type:Individual
Prefix:
First Name:JOYCE
Middle Name:ARLENE
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 1:8220 S INGLESIDE AVE APT 2B
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60619-5544
Mailing Address - Country:US
Mailing Address - Phone:312-912-5059
Mailing Address - Fax:
Practice Address - Street 1:8220 S INGLESIDE AVE APT 2B
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60619-5544
Practice Address - Country:US
Practice Address - Phone:312-912-5059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician