Individual
MRS. JENNIFER ANN JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MOTR/L
Contact information
Practice address
2592 E GRAND AVE STE 209, LINDENHURST, IL 60046-5915
(847) 265-1460
Mailing address
155 ASHTON LN, CRYSTAL LAKE, IL 60014-6239
(574) 274-5804
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
056007452
IL
Other
Enumeration date
11/30/2011
Last updated
04/30/2014
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