Provider Demographics
NPI:1780844993
Name:JOHNS, KRISTOFFER SCOTT (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KRISTOFFER
Middle Name:SCOTT
Last Name:JOHNS
Suffix:
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S STATE ST UNIT 67
Mailing Address - Street 2:
Mailing Address - City:SUTHERLIN
Mailing Address - State:OR
Mailing Address - Zip Code:97479-8503
Mailing Address - Country:US
Mailing Address - Phone:541-459-2421
Mailing Address - Fax:
Practice Address - Street 1:740 NW HILL AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-1672
Practice Address - Country:US
Practice Address - Phone:541-672-1631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR12653235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist