Provider Demographics
NPI:1215633425
Name:JOHNSON, CHRISTY
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8296 N US HIGHWAY 27
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47341-9508
Mailing Address - Country:US
Mailing Address - Phone:765-725-0231
Mailing Address - Fax:
Practice Address - Street 1:8296 N US HIGHWAY 27
Practice Address - Street 2:
Practice Address - City:FOUNTAIN CITY
Practice Address - State:IN
Practice Address - Zip Code:47341-9508
Practice Address - Country:US
Practice Address - Phone:765-725-0231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-31
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22008174A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist