Provider Demographics
NPI:1255693776
Name:JOHNSON, SHAKEITRICE STOKES (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SHAKEITRICE
Middle Name:STOKES
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 KNOX RD
Mailing Address - Street 2:
Mailing Address - City:HARLEM
Mailing Address - State:GA
Mailing Address - Zip Code:30814-4527
Mailing Address - Country:US
Mailing Address - Phone:706-294-2222
Mailing Address - Fax:
Practice Address - Street 1:3624 J DEWEY GRAY CIR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6584
Practice Address - Country:US
Practice Address - Phone:706-651-2270
Practice Address - Fax:706-651-2271
Is Sole Proprietor?:No
Enumeration Date:2012-06-11
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5070235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist