Provider Demographics
NPI:1003408121
Name:JOHNSON, JOSIE LYN (SLP)
Entity type:Individual
Prefix:
First Name:JOSIE
Middle Name:LYN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:JOSIE
Other - Middle Name:LYN
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3003 GRANDVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2821
Mailing Address - Country:US
Mailing Address - Phone:260-224-7032
Mailing Address - Fax:
Practice Address - Street 1:5250 HERITAGE PKWY
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46835-1061
Practice Address - Country:US
Practice Address - Phone:260-209-6279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist