Nick Johnson, PSYD.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

071.007465 Issued in IL

Practice address

3001 Green Bay Rd
North Chicago, IL 60064-3048

Phone

(224) 610-8553

Fax

(847) 688-7411

NPI assigned

Mar 23, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682380800000",
    "number": "1235198532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643048",
            "telephone_number": "224-610-8553",
            "fax_number": "847-688-7411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 GREEN BAY RD",
            "city": "NORTH CHICAGO",
            "state": "IL",
            "postal_code": "600643048",
            "telephone_number": "224-610-8553",
            "fax_number": "847-688-7411"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "NICK",
        "name_prefix": "Dr.",
        "credential": "PSYD.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-23",
        "last_updated": "2023-04-25",
        "certification_date": "2023-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "IN",
            "license": "39001749A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IN",
            "license": "20042393A",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "IL",
            "license": "071.007465",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Allen Johansen, PA-C
• Karleigh Marie Johns
• Cole Johnson, DDS
• Diana L. Johnson, MSW
• Jessica Danielle Johnson, PHARM.D.
• Ivori J. Jones, MSW
• Monica Jones
• Tanesha Shanae' Sadie Jones, NURSE
• Alison M Joseph, DPM
• Jack Olesa Joseph

• Clinical Psychologist in North Chicago, IL
• Providers in North Chicago, IL by specialty
• Clinical Psychologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.