| Authentic Journey, Pllc | |
|
113 Main St Ste 301 Oswego IL 60543-1264 | |
| (630) 631-2354 | |
| (331) 999-3699 |
| Full Name | Authentic Journey, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 113 Main St Ste 301, Oswego, Illinois |
| Authorized Official Name and Position | Heather Johnson (OWNER) |
| Authorized Official Contact | 6306312354 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Authentic Journey, Pllc 113 Main St Ste 301 Oswego IL 60543-1264 Ph: (630) 631-2354 | Authentic Journey, Pllc 113 Main St Ste 301 Oswego IL 60543-1264 Ph: (630) 631-2354 |
| NPI Number | 1972342129 |
|---|---|
| Provider Enumeration Date | 05/20/2024 |
| Last Update Date | 08/23/2024 |
| Certification Date | 08/23/2024 |
| Medicare PECOS PAC ID | 5597208124 |
|---|---|
| Medicare Enrollment ID | O20240624001503 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972342129 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather Johnson |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902208929 PECOS PAC ID: 0244596815 Enrollment ID: I20171207000323 |
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