Provider Demographics
NPI:1316181415
Name:JOHNSON, MEGHAN B
Entity Type:Individual
Prefix:MRS
First Name:MEGHAN
Middle Name:B
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:SAN JUAN BOCES
Mailing Address - Street 2:701 CAMINO DEL RIO SUITE 221
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-247-3261
Mailing Address - Fax:
Practice Address - Street 1:SAN JUAN BOCES
Practice Address - Street 2:701 CAMINO DEL RIO, SUITE 221
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-247-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-21
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8462235Z00000X
SC5321235Z00000X
CO24435529235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist