Provider Demographics
NPI:1184897969
Name:JOHNSTON, LISA ANDREA (SLP)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANDREA
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8134 GRISSOM CIR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-2830
Mailing Address - Country:US
Mailing Address - Phone:210-488-4325
Mailing Address - Fax:
Practice Address - Street 1:5900 EVERS RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1606
Practice Address - Country:US
Practice Address - Phone:210-397-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2022-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101576235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist