Provider Demographics
NPI:1619603479
Name:JOHNSON, RAHN A (SLPA)
Entity Type:Individual
Prefix:
First Name:RAHN
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12984 E WILD HORSE CORRAL DR
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-2537
Mailing Address - Country:US
Mailing Address - Phone:520-222-4239
Mailing Address - Fax:
Practice Address - Street 1:12984 E WILD HORSE CORRAL DR
Practice Address - Street 2:
Practice Address - City:VAIL
Practice Address - State:AZ
Practice Address - Zip Code:85641-2537
Practice Address - Country:US
Practice Address - Phone:520-222-4239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-25
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLPA140072355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant