Provider Demographics
NPI:1568955607
Name:JOHNSON, LAURA ANNE (CCC-SLP, BCS-F)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-SLP, BCS-F
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 TALLYHO LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2127
Mailing Address - Country:US
Mailing Address - Phone:608-217-8960
Mailing Address - Fax:608-238-8342
Practice Address - Street 1:3536 TALLYHO LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2127
Practice Address - Country:US
Practice Address - Phone:608-217-8960
Practice Address - Fax:608-238-8342
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4152-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4152-154OtherWISCONSIN LICENSE