Provider Demographics
NPI:1811212020
Name:JOHNSON, KINSEY
Entity Type:Individual
Prefix:
First Name:KINSEY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18484 PRESTON RD SUITE 102, PMB156
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-5400
Mailing Address - Country:US
Mailing Address - Phone:972-342-7419
Mailing Address - Fax:
Practice Address - Street 1:2100 SAM HOUSTON AVE
Practice Address - Street 2:SUITE D
Practice Address - City:HUNTSVILLE
Practice Address - State:TX
Practice Address - Zip Code:77340-5182
Practice Address - Country:US
Practice Address - Phone:396-293-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX103492235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist