Provider Demographics
NPI:1508492620
Name:JOHNSON, TAMMY LEE
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:JOHNSON
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 1:12 COLONY DR
Mailing Address - Street 2:
Mailing Address - City:WINSTED
Mailing Address - State:CT
Mailing Address - Zip Code:06098-1809
Mailing Address - Country:US
Mailing Address - Phone:860-480-8131
Mailing Address - Fax:860-626-8452
Practice Address - Street 1:1151 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-3983
Practice Address - Country:US
Practice Address - Phone:860-626-8450
Practice Address - Fax:860-626-8452
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000426237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist