Provider Demographics
NPI:1306738026
Name:JOHNSON, ALEXA GABRIELLE (LSW, PEL)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:GABRIELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW, PEL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 W WAYMAN ST APT 104
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60661-1039
Mailing Address - Country:US
Mailing Address - Phone:331-205-9821
Mailing Address - Fax:
Practice Address - Street 1:520 N MARSHFIELD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-6731
Practice Address - Country:US
Practice Address - Phone:312-243-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-17
Last Update Date:2025-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL13719591041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool