Provider Demographics
NPI:1346828423
Name:JOHNSON, DELANEY LYNN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DELANEY
Middle Name:LYNN
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 1:12084 HARMONY CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-7008
Mailing Address - Country:US
Mailing Address - Phone:618-579-6571
Mailing Address - Fax:
Practice Address - Street 1:1108 GRAND AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON CITY
Practice Address - State:IL
Practice Address - Zip Code:62951-1229
Practice Address - Country:US
Practice Address - Phone:618-983-7561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015727235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist