Provider Demographics
NPI:1336480110
Name:JOHNSON, REBECCA LEIGH (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LEIGH
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 1:7470 OLD CAMP RD
Mailing Address - Street 2:
Mailing Address - City:LANEXA
Mailing Address - State:VA
Mailing Address - Zip Code:23089-5134
Mailing Address - Country:US
Mailing Address - Phone:757-784-0264
Mailing Address - Fax:
Practice Address - Street 1:7470 OLD CAMP RD
Practice Address - Street 2:
Practice Address - City:LANEXA
Practice Address - State:VA
Practice Address - Zip Code:23089-5134
Practice Address - Country:US
Practice Address - Phone:757-784-0264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006958235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist