Authentic Journey, PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

AUTHENTIC JOURNEY, PLLC

Practice address

113 Main St Ste 301
Oswego, IL 60543-1264

Phone

(630) 631-2354

Fax

(331) 999-3699

NPI assigned

May 20, 2024

Last updated

Aug 23, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Heather Johnson, LCSWNPI 1902208929

Title

Owner

Phone

(630) 631-2354

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Heather A Johnson, LCSW

  • Clinical Social Worker
  • Oswego, IL
  • NPI 1902208929
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724371200000",
    "number": "1972342129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 MAIN ST STE 301",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605431264",
            "telephone_number": "630-631-2354"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 MAIN ST STE 301",
            "city": "OSWEGO",
            "state": "IL",
            "postal_code": "605431264",
            "telephone_number": "630-631-2354",
            "fax_number": "331-999-3699"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "64 Main St",
            "address_purpose": "LOCATION",
            "city": "Oswego",
            "state": "IL",
            "postal_code": "605439893",
            "country_code": "US",
            "telephone_number": "630-631-2354",
            "fax_number": "331-999-3699",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AUTHENTIC JOURNEY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-08-23",
        "certification_date": "2024-08-23",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "HEATHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-631-2354",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Oswego, IL
• Providers in Oswego, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.