Provider Demographics
NPI:1023354271
Name:JOHNSON, LAURIE B (SLP)
Entity type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAURIE
Other - Middle Name:
Other - Last Name:DUNN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:251 JOHNSTON ST
Mailing Address - Street 2:STE 200
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-2515
Mailing Address - Country:US
Mailing Address - Phone:256-350-1764
Mailing Address - Fax:256-350-7757
Practice Address - Street 1:1800 BEACH DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1553
Practice Address - Country:US
Practice Address - Phone:228-897-4452
Practice Address - Fax:228-388-0017
Is Sole Proprietor?:No
Enumeration Date:2012-12-17
Last Update Date:2017-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS2765235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist