Provider Demographics
NPI:1619024924
Name:JOHNSTON, SALLY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:SALLY
Middle Name:
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 1:1620 SW SUMMIT CT.
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163
Mailing Address - Country:US
Mailing Address - Phone:509-332-5106
Mailing Address - Fax:
Practice Address - Street 1:905 N MEADOW ST
Practice Address - Street 2:
Practice Address - City:MOSCOW
Practice Address - State:ID
Practice Address - Zip Code:83843-9584
Practice Address - Country:US
Practice Address - Phone:208-882-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00002773235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
01108824OtherASHA MEMBER
WALL00002773OtherLISCENSE SPEECH-LANGUAGE