Individual
JACQUELYN L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, CGC
Contact information
Practice address
2200 E WASHINGTON ST, BLOOMINGTON, IL 61701-4364
(309) 665-4849
Mailing address
2200 E WASHINGTON ST, BLOOMINGTON, IL 61701-4364
Taxonomy
Speciality
Code
Description
License number
State
170300000X
Genetic Counselor (M.S.)
Primary
246000255
IL
Other
Enumeration date
05/01/2019
Last updated
10/05/2021
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