Provider Demographics
NPI:1326295726
Name:JOHNSTON, MARK ROBERT (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ROBERT
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 2679
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78299
Mailing Address - Country:US
Mailing Address - Phone:210-616-0121
Mailing Address - Fax:210-614-1003
Practice Address - Street 1:19026 STONE OAK PKWY
Practice Address - Street 2:STE 110
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-545-0404
Practice Address - Fax:210-614-1003
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50770231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist