Provider Demographics
NPI:1245475425
Name:JOHNSON, LAURA D (MED, CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MED, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 DEEP FOREST LN
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:NC
Mailing Address - Zip Code:27527-6270
Mailing Address - Country:US
Mailing Address - Phone:919-550-9110
Mailing Address - Fax:
Practice Address - Street 1:600 DEEP FOREST LN
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27527-6270
Practice Address - Country:US
Practice Address - Phone:919-550-9110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12116016235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist