Provider Demographics
NPI:1215030770
Name:KINKER JOHNSON, JOYCE (MA CCCA)
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:
Last Name:KINKER JOHNSON
Suffix:
Gender:F
Credentials:MA CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3450 W CENTRAL AVE
Mailing Address - Street 2:STE #134
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606
Mailing Address - Country:US
Mailing Address - Phone:419-534-3111
Mailing Address - Fax:419-534-3113
Practice Address - Street 1:3450 W CENTRAL AVE
Practice Address - Street 2:STE #134
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606
Practice Address - Country:US
Practice Address - Phone:419-534-3111
Practice Address - Fax:419-534-3113
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA0114OHIO231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R63811Medicare UPIN
OH091502Medicare ID - Type Unspecified