Provider Demographics
NPI:1881584084
Name:MIZER, JOHN A (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:A
Last Name:MIZER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:A
Other - Last Name:MIZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:42 WOODS MILL RD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684-9707
Mailing Address - Country:US
Mailing Address - Phone:217-891-7882
Mailing Address - Fax:
Practice Address - Street 1:42 WOODS MILL RD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684-9707
Practice Address - Country:US
Practice Address - Phone:217-891-7882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0267941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty