Individual
DR. THOR JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
4801 W PETERSON AVE STE 303, CHICAGO, IL 60646-5726
(773) 282-2322
Mailing address
3329 N HOYNE AVE # 1, CHICAGO, IL 60618-6243
(773) 428-2449
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
71007301
IL
Other
Enumeration date
07/05/2007
Last updated
07/08/2007
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