Individual
NICOLE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMT
Contact information
Practice address
430 BARRON BLVD, GRAYSLAKE, IL 60030-1666
(847) 548-4800
Mailing address
430 BARRON BLVD, GRAYSLAKE, IL 60030-1666
(847) 548-4800
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
Primary
227010219
IL
Other
Enumeration date
09/04/2014
Last updated
09/04/2014
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