Provider Demographics
NPI:1174673701
Name:JOHNSON-MCJUNKINS, KRISTEN (SLP)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:JOHNSON-MCJUNKINS
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:313 DEERWOOD LN
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-8459
Mailing Address - Country:US
Mailing Address - Phone:870-451-9927
Mailing Address - Fax:
Practice Address - Street 1:313 DEERWOOD LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-8459
Practice Address - Country:US
Practice Address - Phone:870-451-9927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2018-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP1735235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR156458721Medicaid
AR5Y422OtherBLUECROSS BLUESHIELD