Individual
SHANNON JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
430 PENNSYLVANIA AVE STE 240, GLEN ELLYN, IL 60137-4464
(630) 790-1872
(630) 545-7850
Mailing address
POB 7132960, CHICAGO, IL 60677-0001
(630) 469-9200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-010958
IL
Other
Enumeration date
07/06/2023
Last updated
04/25/2025
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