Provider Demographics
NPI:1497133904
Name:JOHNSON, LANAE MARIE (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:LANAE
Middle Name:MARIE
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 1:1120 TOPSAIL COMMON DR
Mailing Address - Street 2:APT 301
Mailing Address - City:KNIGHTDALE
Mailing Address - State:NC
Mailing Address - Zip Code:27545-7111
Mailing Address - Country:US
Mailing Address - Phone:252-619-6414
Mailing Address - Fax:
Practice Address - Street 1:1120 TOPSAIL COMMON DR
Practice Address - Street 2:APT 301
Practice Address - City:KNIGHTDALE
Practice Address - State:NC
Practice Address - Zip Code:27545-7111
Practice Address - Country:US
Practice Address - Phone:252-619-6414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist