Provider Demographics
NPI:1942475389
Name:JOHNSON-BOLES, KARI ANN (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:KARI
Middle Name:ANN
Last Name:JOHNSON-BOLES
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 GRACE PL
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-3069
Mailing Address - Country:US
Mailing Address - Phone:417-425-2575
Mailing Address - Fax:
Practice Address - Street 1:2700 BUTTERFIELD COACH RD
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-8767
Practice Address - Country:US
Practice Address - Phone:479-750-8740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP2575235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist