Provider Demographics
NPI:1366216236
Name:JOHNSON, MONICA YVONNE (LMSW)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:YVONNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9259 ILLINOIS HIGHWAY 81
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:61238-9206
Mailing Address - Country:US
Mailing Address - Phone:309-945-6307
Mailing Address - Fax:
Practice Address - Street 1:2826 W LOCUST ST STE 2A
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52804-3354
Practice Address - Country:US
Practice Address - Phone:563-445-8680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-13
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA085914104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker