Provider Demographics
NPI:1558691980
Name:JOHNSON, JEAN H
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:BETH
Other - Last Name:HANSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5084 WOODBRAE CT
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:CA
Mailing Address - Zip Code:95070-4756
Mailing Address - Country:US
Mailing Address - Phone:408-888-0009
Mailing Address - Fax:408-370-6577
Practice Address - Street 1:405 ALBERTO WAY
Practice Address - Street 2:SUITES D, E AND 5
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5406
Practice Address - Country:US
Practice Address - Phone:408-888-0009
Practice Address - Fax:408-370-6577
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP3196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist