Provider Demographics
NPI:1942937164
Name:JOHNSON, ABIGAIL LENA (MED, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:LENA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 STONELAKE COVE AVE APT 11205
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7910
Mailing Address - Country:US
Mailing Address - Phone:702-696-8054
Mailing Address - Fax:
Practice Address - Street 1:309 W LAKE MEAD PKWY UNIT 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-7056
Practice Address - Country:US
Practice Address - Phone:702-550-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty