Provider Demographics
NPI:1164060612
Name:JOHNSON, SHELBY MORGAN (MS, CCLS)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:MORGAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CCLS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 ARGYLE ST
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-2706
Mailing Address - Country:US
Mailing Address - Phone:978-809-9223
Mailing Address - Fax:
Practice Address - Street 1:11 ARGYLE ST
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-2706
Practice Address - Country:US
Practice Address - Phone:978-809-9223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist