Provider Demographics
NPI:1134322886
Name:PRICE, JOHANNA R (PHD CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:R
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COLLEGE STREET MUW 1340
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39701
Mailing Address - Country:US
Mailing Address - Phone:662-329-7270
Mailing Address - Fax:662-329-7460
Practice Address - Street 1:1100 COLLEGE STREET MUW 1340
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701
Practice Address - Country:US
Practice Address - Phone:662-329-7270
Practice Address - Fax:662-329-7460
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3172235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist