Provider Demographics
NPI:1508084237
Name:PAINTER, JOHANNA DAWN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:DAWN
Last Name:PAINTER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:DAWN
Other - Last Name:FRENSEMEIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:7782 W. STATE RD 46
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240
Mailing Address - Country:US
Mailing Address - Phone:812-216-9067
Mailing Address - Fax:812-933-9048
Practice Address - Street 1:7782 W. STATE RD 46
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240
Practice Address - Country:US
Practice Address - Phone:812-216-9067
Practice Address - Fax:812-933-9048
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002819235Z00000X
IN22002819A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200606120OtherRENDERING PROVIDER NUMBER
IN200705660AMedicaid