Provider Demographics
NPI:1134270564
Name:JOHNSON, ROSYLYNN (CCC-SLP, MED)
Entity type:Individual
Prefix:MISS
First Name:ROSYLYNN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC-SLP, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 SHEFFIELD CT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-2100
Mailing Address - Country:US
Mailing Address - Phone:205-824-3775
Mailing Address - Fax:205-824-3778
Practice Address - Street 1:128 SHEFFIELD CT
Practice Address - Street 2:
Practice Address - City:HOOVER
Practice Address - State:AL
Practice Address - Zip Code:35226-2100
Practice Address - Country:US
Practice Address - Phone:205-824-3775
Practice Address - Fax:205-824-3778
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1560235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist