Individual
MELVENA JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
900 RIDGE RD STE 2D-E, HOMEWOOD, IL 60430-1933
(312) 609-9535
Mailing address
314 ALLEGHENY ST, PARK FOREST, IL 60466-1462
Taxonomy
Speciality
Code
Description
License number
State
225700000X
Massage Therapist
22007100
IN
225700000X
Massage Therapist
Primary
227021103
IL
Other
Enumeration date
07/24/2020
Last updated
07/24/2020
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