Provider Demographics
NPI:1629320320
Name:JOHNSON, ELIZABETH JANE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:JANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:JANE
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, CCC-SLP
Mailing Address - Street 1:1119 N. 5TH ST.
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66101
Mailing Address - Country:US
Mailing Address - Phone:913-281-8695
Mailing Address - Fax:913-281-8699
Practice Address - Street 1:1119 N. 5TH ST.
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66101
Practice Address - Country:US
Practice Address - Phone:913-281-8695
Practice Address - Fax:913-281-8699
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS3232235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist