Provider Demographics
NPI:1467077172
Name:JOHNSON, TAYLOR ALISE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:ALISE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 LASA DR APT 204
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-8770
Mailing Address - Country:US
Mailing Address - Phone:404-791-1462
Mailing Address - Fax:
Practice Address - Street 1:1159 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32250-3445
Practice Address - Country:US
Practice Address - Phone:904-450-5061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist