Provider Demographics
NPI:1427446269
Name:JOHNSON, EMMY
Entity type:Individual
Prefix:
First Name:EMMY
Middle Name:
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 1:5537 N CLARK ST
Mailing Address - Street 2:UNIT B-1
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-1222
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5537 N CLARK ST
Practice Address - Street 2:UNIT B-1
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-1222
Practice Address - Country:US
Practice Address - Phone:773-368-9619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-01
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0178771041C0700X, 1041C0700X
IL32137101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)