Provider Demographics
NPI:1881656320
Name:JOHNSON, SHARON ELIZABETH (MA, CCC-A)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELIZABETH
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 1:920 E 1ST ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2201
Mailing Address - Country:US
Mailing Address - Phone:218-279-6279
Mailing Address - Fax:218-279-6280
Practice Address - Street 1:920 E 1ST ST
Practice Address - Street 2:SUITE 301
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55805-2201
Practice Address - Country:US
Practice Address - Phone:218-279-6279
Practice Address - Fax:218-279-6280
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5336231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN614009OtherARAZ
MN46A09J0OtherBLUE CROSS & BLUE SHIELD
MN00045927OtherRAILROAD RETIREMENT
MN1013454OtherPREFERRED ONE
MN45-0-0005OtherMEDICA
MN06238OtherNATIONAL EAR CARE PLAN
MN1013454OtherPREFERRED ONE