Provider Demographics
NPI:1346550886
Name:JOHNSON, KATHERINE LANG (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:LANG
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 REESE DR
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2612
Mailing Address - Country:US
Mailing Address - Phone:512-461-4938
Mailing Address - Fax:
Practice Address - Street 1:2011 BROADWAY ST STE 130
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-5945
Practice Address - Country:US
Practice Address - Phone:512-461-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX105860235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist