Provider Demographics
NPI:1740602010
Name:JOHNSON, ANNA RACHEL (MA CCC SLP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RACHEL
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5574 COYOTE CT
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-7156
Mailing Address - Country:US
Mailing Address - Phone:760-519-8405
Mailing Address - Fax:
Practice Address - Street 1:5574 COYOTE CT
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92010-7156
Practice Address - Country:US
Practice Address - Phone:760-519-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-06
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12747235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist