Provider Demographics
NPI:1013225945
Name:JOHNSON, SUSAN D (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PLUMER RD
Mailing Address - Street 2:UNIT 26
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-1709
Mailing Address - Country:US
Mailing Address - Phone:603-679-8367
Mailing Address - Fax:
Practice Address - Street 1:750 CENTRAL AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-3434
Practice Address - Country:US
Practice Address - Phone:603-926-3277
Practice Address - Fax:603-926-3271
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1109235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist