Provider Demographics
NPI:1467975748
Name:GARNEAU, JOHANNA LOUISE
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:LOUISE
Last Name:GARNEAU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1480 E PECOS RD APT 2025
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-1837
Mailing Address - Country:US
Mailing Address - Phone:714-365-0905
Mailing Address - Fax:
Practice Address - Street 1:1480 E PECOS RD APT 2025
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-1837
Practice Address - Country:US
Practice Address - Phone:714-365-0905
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA103102355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language AssistantGroup - Single Specialty