Individual
MRS. LANISE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
399 MERRILL AVE, CALUMET CITY, IL 60409-2227
(708) 203-3760
Mailing address
399 MERRILL AVE, CALUMET CITY, IL 60409-2227
(708) 203-3760
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Enumeration date
12/24/2016
Last updated
12/24/2016
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