Provider Demographics
NPI:1730074428
Name:JOHNSON, JESECA ARLEASE
Entity type:Individual
Prefix:
First Name:JESECA
Middle Name:ARLEASE
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 1:19030 WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COUNTRY CLUB HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60478-5741
Mailing Address - Country:US
Mailing Address - Phone:708-310-1174
Mailing Address - Fax:
Practice Address - Street 1:611 W JEFFERSON ST STE 201
Practice Address - Street 2:
Practice Address - City:SHOREWOOD
Practice Address - State:IL
Practice Address - Zip Code:60404-3772
Practice Address - Country:US
Practice Address - Phone:630-281-2496
Practice Address - Fax:630-839-9138
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor