Individual
DR. SUSANNE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
728 OGDEN AVE, STE E, DOWNERS GROVE, IL 60515-2901
(630) 640-2980
Mailing address
728 OGDEN AVE, STE E, DOWNERS GROVE, IL 60515-2901
(630) 640-2980
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071006253
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2227588
BLUECROSSBLUESHIELD
IL
01
—
IP558185
MAGELLAN BEHAVIORAL HEALT
—
Enumeration date
08/01/2006
Last updated
05/11/2016
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