Provider Demographics
NPI:1255636015
Name:JOHANSEN, YVONNE ANN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:ANN
Last Name:JOHANSEN
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:MISS
Other - First Name:YVONNE
Other - Middle Name:ANN
Other - Last Name:KORDICH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS,CCC-SLP
Mailing Address - Street 1:424 N LAKE AVE
Mailing Address - Street 2:SUITE 304
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1200
Mailing Address - Country:US
Mailing Address - Phone:818-623-8681
Mailing Address - Fax:
Practice Address - Street 1:424 N LAKE AVE
Practice Address - Street 2:SUITE 304
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1200
Practice Address - Country:US
Practice Address - Phone:626-793-9444
Practice Address - Fax:626-793-9499
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12624235Z00000X
NY12624235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist