Provider Demographics
NPI:1558352088
Name:JOHNSTON, TARA M (AUD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 FM 359 RD
Mailing Address - Street 2:# 324
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-1296
Mailing Address - Country:US
Mailing Address - Phone:979-250-1335
Mailing Address - Fax:
Practice Address - Street 1:1856 FM 359 RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-1296
Practice Address - Country:US
Practice Address - Phone:866-714-7495
Practice Address - Fax:979-383-2292
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51343231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F22077Medicare PIN