Provider Demographics
NPI:1740575521
Name:JOHNSON, CAROL MANIACI (AUD, CCC-A)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:MANIACI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4806
Mailing Address - Country:US
Mailing Address - Phone:407-303-5466
Mailing Address - Fax:407-303-5467
Practice Address - Street 1:711 E ALTAMONTE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4806
Practice Address - Country:US
Practice Address - Phone:407-303-5466
Practice Address - Fax:407-303-5467
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-09
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1043231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist