Individual
STEPHANY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RD
Contact information
Practice address
8603 N UNIVERSITY ST, PEORIA, IL 61615-1631
(309) 226-6080
Mailing address
1223 E HALLOCK HOLLOW RD, CHILLICOTHE, IL 61523-9545
(309) 360-0659
Taxonomy
Speciality
Code
Description
License number
State
133V00000X
Registered Dietitian
Primary
164.007222
IL
Other
Enumeration date
10/22/2017
Last updated
10/22/2017
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