Provider Demographics
NPI:1376888925
Name:JOHNSON, ELIZABETH ANNE (MT-BC)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MT-BC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:ANNE
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT-BC
Mailing Address - Street 1:7770 E VALLEY VISTA LN
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-4730
Mailing Address - Country:US
Mailing Address - Phone:602-828-7144
Mailing Address - Fax:
Practice Address - Street 1:1355 S HIGLEY RD
Practice Address - Street 2:BUILDING 5, SUITE 111
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4799
Practice Address - Country:US
Practice Address - Phone:480-474-4173
Practice Address - Fax:480-237-9727
Is Sole Proprietor?:No
Enumeration Date:2012-12-09
Last Update Date:2012-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09058225A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist