Individual
DR. ILA B JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5010 MAYFIELD RD, SUITE 103, CLEVELAND, OH 44124-2611
(216) 291-1550
Mailing address
5010 MAYFIELD RD, SUITE 103, CLEVELAND, OH 44124-2611
(216) 291-1550
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
321
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000116299
ANTHEM BC/BS
OH
05
—
0241796
—
OH
Enumeration date
05/22/2006
Last updated
09/15/2008
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