Provider Demographics
NPI:1124373568
Name:JOHNSON, GEORGIA (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:GEORGIA
Other - Middle Name:
Other - Last Name:STRAWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10609 IH 10 W
Mailing Address - Street 2:201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1672
Mailing Address - Country:US
Mailing Address - Phone:210-344-5437
Mailing Address - Fax:210-344-5535
Practice Address - Street 1:10609 IH 10 W
Practice Address - Street 2:201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1672
Practice Address - Country:US
Practice Address - Phone:210-344-5437
Practice Address - Fax:210-344-5535
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12475235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist