Provider Demographics
NPI:1073167144
Name:JOHNSTON, WRELA (MS-CCC SLP)
Entity Type:Individual
Prefix:
First Name:WRELA
Middle Name:
Last Name:JOHNSTON
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 1:2827 SUTTER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914-2645
Mailing Address - Country:US
Mailing Address - Phone:724-816-6322
Mailing Address - Fax:
Practice Address - Street 1:2827 SUTTER RIDGE DR
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914-2645
Practice Address - Country:US
Practice Address - Phone:724-816-6322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18465235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist