Provider Demographics
NPI:1013240209
Name:JOHNSON, TONI DARLENE (CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:TONI
Middle Name:DARLENE
Last Name:JOHNSON
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 1:7387 BRAMBLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46254-9715
Mailing Address - Country:US
Mailing Address - Phone:317-291-0809
Mailing Address - Fax:
Practice Address - Street 1:1801 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46240-2345
Practice Address - Country:US
Practice Address - Phone:317-259-5301
Practice Address - Fax:317-259-5369
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-07
Last Update Date:2009-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22001051A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist