Provider Demographics
NPI:1679752513
Name:JOHNSON, SARA ROSENFELD (MS/CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ROSENFELD
Last Name:JOHNSON
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 1:5746 N VIA JOYITA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85750-1152
Mailing Address - Country:US
Mailing Address - Phone:520-529-6474
Mailing Address - Fax:
Practice Address - Street 1:3420 N DODGE BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1464
Practice Address - Country:US
Practice Address - Phone:520-795-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-28
Last Update Date:2007-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0563235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist