Provider Demographics
NPI:1134751100
Name:JOHNSON, DENISE DA PRA (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:DA PRA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:DA PRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 SALERNO WAY
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-7148
Mailing Address - Country:US
Mailing Address - Phone:561-501-1983
Mailing Address - Fax:561-270-6965
Practice Address - Street 1:2900 SALERNO WAY
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33445-7148
Practice Address - Country:US
Practice Address - Phone:561-501-1983
Practice Address - Fax:561-270-6965
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2020-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA587235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist