Provider Demographics
NPI:1962488338
Name:JOHNSON, SUSAN L (LSW)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:L
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:L
Other - Last Name:DIGIOVANNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16325 HARLEM AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TINLEY PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60477-2509
Mailing Address - Country:US
Mailing Address - Phone:708-429-6999
Mailing Address - Fax:708-429-6909
Practice Address - Street 1:16325 HARLEM AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TINLEY PARK
Practice Address - State:IL
Practice Address - Zip Code:60477-2509
Practice Address - Country:US
Practice Address - Phone:708-429-6999
Practice Address - Fax:708-429-6909
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical