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Individual

JANESSA JOHNSON

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
5034 W DIVISION ST # 2, CHICAGO, IL 60651-3017
(773) 354-0253
Mailing address
5034 W DIVISION ST # 2, CHICAGO, IL 60651-3017
(773) 354-0253

Taxonomy

Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
J52543287793
IL

Other

Enumeration date
01/04/2022
Last updated
01/04/2022
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