Provider Demographics
NPI:1235590175
Name:JOHNSON, KAYLA RENEE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KAYLA
Middle Name:RENEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1130 BAKER RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:PA
Mailing Address - Zip Code:16323-7403
Mailing Address - Country:US
Mailing Address - Phone:814-758-4693
Mailing Address - Fax:
Practice Address - Street 1:758 CONGRESS HILL RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:PA
Practice Address - Zip Code:16323-3612
Practice Address - Country:US
Practice Address - Phone:814-657-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL012853235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1028641660001Medicaid