Provider Demographics
NPI:1255378881
Name:JOHNSON III, WILLIAM ELLSWORTH (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ELLSWORTH
Last Name:JOHNSON III
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:209 S OAK PARK AVE
Mailing Address - Street 2:APT. 402
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60302-3262
Mailing Address - Country:US
Mailing Address - Phone:708-383-5032
Mailing Address - Fax:
Practice Address - Street 1:5TH AVE AT ROOSEVELT RD.
Practice Address - Street 2:EDWARD HINES JR. VA HOSPITAL, BLDG 200 ROOM 610
Practice Address - City:HINES
Practice Address - State:IL
Practice Address - Zip Code:60141-5122
Practice Address - Country:US
Practice Address - Phone:708-202-2101
Practice Address - Fax:708-202-2346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical