Provider Demographics
NPI:1275800872
Name:FLICKER, JOHANNA J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:J
Last Name:FLICKER
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 1:18510 KINGBIRD DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33558-2707
Mailing Address - Country:US
Mailing Address - Phone:954-298-7540
Mailing Address - Fax:
Practice Address - Street 1:18510 KINGBIRD DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-2707
Practice Address - Country:US
Practice Address - Phone:954-298-7540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-27
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10849235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist