Provider Demographics
NPI:1821406117
Name:JOHNSTON, LEANNE
Entity Type:Individual
Prefix:MRS
First Name:LEANNE
Middle Name:
Last Name:JOHNSTON
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 1:4301 LAKE WASHINGTON BLVD NE
Mailing Address - Street 2:APT 1314
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-7882
Mailing Address - Country:US
Mailing Address - Phone:425-209-5476
Mailing Address - Fax:
Practice Address - Street 1:710 NW JUNIPER ST
Practice Address - Street 2:SUITE 110
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-2717
Practice Address - Country:US
Practice Address - Phone:425-392-2631
Practice Address - Fax:425-392-4631
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-30
Last Update Date:2014-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL 60474516235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist