Provider Demographics
NPI:1760933345
Name:JOHNSON, FAYE M (CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:FAYE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58703-1869
Mailing Address - Country:US
Mailing Address - Phone:701-857-4590
Mailing Address - Fax:701-857-8762
Practice Address - Street 1:501 25TH ST NW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58703-1869
Practice Address - Country:US
Practice Address - Phone:701-857-4590
Practice Address - Fax:701-857-8762
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-19
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist