Provider Demographics
NPI:1548576606
Name:JOHNSON CHRISTENSEN, ALICE R (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:R
Last Name:JOHNSON CHRISTENSEN
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-0719
Mailing Address - Country:US
Mailing Address - Phone:917-703-0782
Mailing Address - Fax:732-928-4181
Practice Address - Street 1:627 WINTERBERRY BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5343
Practice Address - Country:US
Practice Address - Phone:917-703-0782
Practice Address - Fax:732-928-4181
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY009247-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist