Provider Demographics
NPI:1790167120
Name:JOHNSON, LEANN (AUD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 SPINNAKER BAY DR
Mailing Address - Street 2:STE E
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7533
Mailing Address - Country:US
Mailing Address - Phone:970-682-1950
Mailing Address - Fax:970-631-8869
Practice Address - Street 1:8201 SPINNAKER BAY DR
Practice Address - Street 2:STE E
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-7533
Practice Address - Country:US
Practice Address - Phone:970-682-1950
Practice Address - Fax:970-631-8869
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO772231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist