Provider Demographics
NPI:1245786573
Name:JOHNSON, ALYSHA
Entity Type:Individual
Prefix:
First Name:ALYSHA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 327
Mailing Address - Street 2:
Mailing Address - City:HAYTI
Mailing Address - State:SD
Mailing Address - Zip Code:57241-0327
Mailing Address - Country:US
Mailing Address - Phone:605-783-3607
Mailing Address - Fax:605-783-3259
Practice Address - Street 1:310 5 STREET
Practice Address - Street 2:
Practice Address - City:HAYTI
Practice Address - State:SD
Practice Address - Zip Code:57241
Practice Address - Country:US
Practice Address - Phone:605-783-3607
Practice Address - Fax:605-783-3259
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD578-PROV235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist