Provider Demographics
NPI:1902208929
Name:JOHNSON, HEATHER A (LCSW)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 MAIN ST STE 301
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:IL
Mailing Address - Zip Code:60543-1264
Mailing Address - Country:US
Mailing Address - Phone:630-631-2354
Mailing Address - Fax:331-999-3699
Practice Address - Street 1:113 MAIN ST STE 301
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:IL
Practice Address - Zip Code:60543-1264
Practice Address - Country:US
Practice Address - Phone:630-631-2354
Practice Address - Fax:331-999-3699
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490133401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical