Individual
JACK JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RSA
Contact information
Practice address
219 W CHICAGO AVE, CHICAGO, IL 60654-5600
(872) 777-8110
Mailing address
18555 WESTERN AVE, HOMEWOOD, IL 60430-3116
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/08/2024
Last updated
05/08/2024
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