Provider Demographics
NPI:1437385671
Name:JOHNSTON, HEATHER MARIE (MS)
Entity Type:Individual
Prefix:MS
First Name:HEATHER
Middle Name:MARIE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1459 35TH ST S
Mailing Address - Street 2:306
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3432
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:317 UNIVERSITY DR S
Practice Address - Street 2:STE B
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1762
Practice Address - Country:US
Practice Address - Phone:701-261-4708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN443755235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist