Provider Demographics
NPI:1790031326
Name:JOHNSON, KENYA K (MS CCC SLP)
Entity Type:Individual
Prefix:
First Name:KENYA
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6191 N STATE HIGHWAY 161
Mailing Address - Street 2:STE 650
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-2246
Mailing Address - Country:US
Mailing Address - Phone:972-812-3299
Mailing Address - Fax:505-468-8520
Practice Address - Street 1:4305 CUTTER SPRINGS CT
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-3740
Practice Address - Country:US
Practice Address - Phone:214-498-3450
Practice Address - Fax:972-618-0474
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102956235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist