Provider Demographics
NPI:1952475188
Name:JOHNSON, KRISTAL G (SLP)
Entity Type:Individual
Prefix:MRS
First Name:KRISTAL
Middle Name:G
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:MRS
Other - First Name:KRISTAL
Other - Middle Name:G
Other - Last Name:GRAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:5800 BELL ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79109-6230
Mailing Address - Country:US
Mailing Address - Phone:806-677-5226
Mailing Address - Fax:806-677-5225
Practice Address - Street 1:5800 BELL ST
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79109-6230
Practice Address - Country:US
Practice Address - Phone:806-677-5226
Practice Address - Fax:806-677-5225
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2903OtherBCBS ID