Provider Demographics
NPI:1821083403
Name:JOHNSON, DONNA M (MA CCC-A)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4275 STEELS POINTE
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-6841
Mailing Address - Country:US
Mailing Address - Phone:330-923-0399
Mailing Address - Fax:330-923-6677
Practice Address - Street 1:4275 STEELS POINTE
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-6841
Practice Address - Country:US
Practice Address - Phone:330-923-0399
Practice Address - Fax:330-923-6677
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2014-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA00772231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH341713667028OtherCARESOURCE
OH0883441Medicaid
OH45-00027OtherUNITED HEALTHCARE
OH010048593OtherRAILROAD
OH61248OtherQUALCHOICE
OH000000137223OtherANTHEM
OH61248OtherQUALCHOICE