Provider Demographics
NPI:1962827204
Name:JOHNSTON, KAREN ANN (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11731 MOUNT OVERLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-1025
Mailing Address - Country:US
Mailing Address - Phone:216-795-8094
Mailing Address - Fax:
Practice Address - Street 1:11731 MOUNT OVERLOOK AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-1025
Practice Address - Country:US
Practice Address - Phone:216-795-8094
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP-3016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSP-3016OtherSTATE LICENSE TO PRACTICE SPEECH/LANGUAGE PATHOLOGY