Individual
ELAINE JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
818 E GRASS LAKE RD, LAKE VILLA, IL 60046-7470
(847) 838-8639
Mailing address
2480 BRIDLE CT, ROUND LAKE BEACH, IL 60073-4130
(847) 912-1862
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
146006078
IL
Other
Enumeration date
09/04/2020
Last updated
09/10/2020
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