Provider Demographics
NPI:1285861021
Name:JOHNSON, CARRIE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:
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 1:500 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ANNA
Mailing Address - State:TX
Mailing Address - Zip Code:75409-5095
Mailing Address - Country:US
Mailing Address - Phone:972-832-5229
Mailing Address - Fax:
Practice Address - Street 1:500 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:ANNA
Practice Address - State:TX
Practice Address - Zip Code:75409-5095
Practice Address - Country:US
Practice Address - Phone:972-832-5229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-19
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24480235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist