Provider Demographics
NPI:1467128447
Name:JOHNSON, LIANORA GRANGER (MA)
Entity Type:Individual
Prefix:MRS
First Name:LIANORA
Middle Name:GRANGER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2217 FOOT HILL RD
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3679
Mailing Address - Country:US
Mailing Address - Phone:575-302-5538
Mailing Address - Fax:
Practice Address - Street 1:408 N CANYON ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5812
Practice Address - Country:US
Practice Address - Phone:575-234-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist