Provider Demographics
NPI:1750598728
Name:JOHNSON, SARA BETH (MSW, LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:BETH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MSW, LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S MAPLE AVE
Mailing Address - Street 2:SUITE 5300
Mailing Address - City:OAK PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60304-1091
Mailing Address - Country:US
Mailing Address - Phone:708-660-4300
Mailing Address - Fax:708-660-4301
Practice Address - Street 1:1010 LAKE ST STE 500
Practice Address - Street 2:
Practice Address - City:OAK PARK
Practice Address - State:IL
Practice Address - Zip Code:60301-1135
Practice Address - Country:US
Practice Address - Phone:773-665-8052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490094921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical