Provider Demographics
NPI:1578211207
Name:JOHNSON, VALERIE (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SIMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:95616-2422
Mailing Address - Country:US
Mailing Address - Phone:406-781-4889
Mailing Address - Fax:
Practice Address - Street 1:31 SIMMONS WAY
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-2422
Practice Address - Country:US
Practice Address - Phone:406-781-4889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-11
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31061235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist