Provider Demographics
NPI:1194724393
Name:JOHNSON, STEVEN P (PHD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:P
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 N KENNICOTT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1470
Mailing Address - Country:US
Mailing Address - Phone:847-508-2926
Mailing Address - Fax:847-368-0764
Practice Address - Street 1:3405 N KENNICOTT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1470
Practice Address - Country:US
Practice Address - Phone:847-508-2926
Practice Address - Fax:847-368-0764
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005462103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL591090Medicare ID - Type Unspecified