Provider Demographics
NPI:1073254710
Name:JOHNSON, DIANNE LYN (MS, CCC-SLP, CBIS)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCC-SLP, CBIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 RANGER ST
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-5122
Mailing Address - Country:US
Mailing Address - Phone:214-686-1828
Mailing Address - Fax:
Practice Address - Street 1:711 RANGER ST
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-5122
Practice Address - Country:US
Practice Address - Phone:214-686-1828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110234235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist