Provider Demographics
NPI:1376893651
Name:JOHNSON, JOSLIN RINETTA (LICENSE)
Entity Type:Individual
Prefix:MS
First Name:JOSLIN
Middle Name:RINETTA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LICENSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3925 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1115
Mailing Address - Country:US
Mailing Address - Phone:510-482-9176
Mailing Address - Fax:510-698-4884
Practice Address - Street 1:9801 DUBLIN BLVD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-2835
Practice Address - Country:US
Practice Address - Phone:877-543-7852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1067235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist