Provider Demographics
NPI:1518409614
Name:JOHNSON, KRISTEN LEIGH (MS, CF-SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:LEIGH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:MISS
Other - First Name:KRISTEN
Other - Middle Name:LEIGH
Other - Last Name:CELSOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:70 COUNTRY CLUB CIR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-8904
Mailing Address - Country:US
Mailing Address - Phone:501-827-3415
Mailing Address - Fax:
Practice Address - Street 1:1620 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CENTRALIA
Practice Address - State:WA
Practice Address - Zip Code:98531-4533
Practice Address - Country:US
Practice Address - Phone:360-330-7633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-07
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASI 60689602235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist