Provider Demographics
NPI:1972342129
Name:AUTHENTIC JOURNEY, PLLC
Entity type:Organization
Organization Name:AUTHENTIC JOURNEY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:630-631-2354
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:
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-20
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty