Provider Demographics
NPI:1225368996
Name:JOHNSON, JANE T (SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:T
Last Name:JOHNSON
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 1:22714 SOFIE RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:WA
Mailing Address - Zip Code:98272-7682
Mailing Address - Country:US
Mailing Address - Phone:360-805-0323
Mailing Address - Fax:
Practice Address - Street 1:22714 SOFIE RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:WA
Practice Address - Zip Code:98272-7682
Practice Address - Country:US
Practice Address - Phone:360-805-0323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-01
Last Update Date:2010-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60117805235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist