Provider Demographics
NPI:1417118217
Name:JOHNSON, GARY MICHAEL II (AUD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:MICHAEL
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1625 N 87TH ST
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-2922
Mailing Address - Country:US
Mailing Address - Phone:480-429-0026
Mailing Address - Fax:480-429-0028
Practice Address - Street 1:1625 N 87TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2922
Practice Address - Country:US
Practice Address - Phone:480-429-0026
Practice Address - Fax:480-429-0028
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA5875237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter