Provider Demographics
NPI:1578798328
Name:JOHNSTON, ELIZABETH ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:JOHNSTON
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 1:5987 N 4413 RD
Mailing Address - Street 2:
Mailing Address - City:ADAIR
Mailing Address - State:OK
Mailing Address - Zip Code:74330-3220
Mailing Address - Country:US
Mailing Address - Phone:918-785-2530
Mailing Address - Fax:
Practice Address - Street 1:510 S ELLIOTT ST
Practice Address - Street 2:SUITE C
Practice Address - City:PRYOR
Practice Address - State:OK
Practice Address - Zip Code:74361-6421
Practice Address - Country:US
Practice Address - Phone:918-825-4837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-22
Last Update Date:2009-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3478235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist