Provider Demographics
NPI:1083497531
Name:JOHNSON, JADE
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 W CANAL ST
Mailing Address - Street 2:
Mailing Address - City:SPALDING
Mailing Address - State:NE
Mailing Address - Zip Code:68665-6011
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:124 S ASH ST
Practice Address - Street 2:
Practice Address - City:SPALDING
Practice Address - State:NE
Practice Address - Zip Code:68665-6182
Practice Address - Country:US
Practice Address - Phone:308-746-4760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant