Provider Demographics
NPI:1871224386
Name:JOHNSON, JILLIAN SKYE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JILLIAN
Middle Name:SKYE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:814 SHADOW LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9138
Mailing Address - Country:US
Mailing Address - Phone:919-285-1647
Mailing Address - Fax:919-576-1366
Practice Address - Street 1:10844 PROVIDENCE RD STE 225
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-4107
Practice Address - Country:US
Practice Address - Phone:919-285-1647
Practice Address - Fax:919-576-1366
Is Sole Proprietor?:No
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist