Provider Demographics
NPI:1720227903
Name:JOHNSON, VIKI DELANE (SLP)
Entity Type:Individual
Prefix:
First Name:VIKI
Middle Name:DELANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12710 RESEARCH BLVD
Mailing Address - Street 2:#395
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4379
Mailing Address - Country:US
Mailing Address - Phone:512-331-4115
Mailing Address - Fax:512-331-8176
Practice Address - Street 1:12710 RESEARCH BLVD
Practice Address - Street 2:#395
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4379
Practice Address - Country:US
Practice Address - Phone:512-331-4115
Practice Address - Fax:512-331-8176
Is Sole Proprietor?:No
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12477235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist