Individual
MS. LISA MARLOW JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
34 FENWOOD DR, BELLEVILLE, IL 62220
(618) 292-9659
Mailing address
34 FENWOOD DR, BELLEVILLE, IL 62220
(618) 292-9659
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
07/23/2009
Last updated
07/23/2009
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