Provider Demographics
NPI:1639252927
Name:JOHNSTON, NANCY J (MS/CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:NANCY
Middle Name:J
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 1:2222 NICOLET DR APT 2
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-7467
Mailing Address - Country:US
Mailing Address - Phone:920-468-2064
Mailing Address - Fax:920-498-2394
Practice Address - Street 1:2222 NICOLET DR APT 2
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-7467
Practice Address - Country:US
Practice Address - Phone:920-468-2064
Practice Address - Fax:920-498-2394
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1586-154235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist