Provider Demographics
NPI:1265589725
Name:JOHNSON, DARRYL E (MA, FA,AA)
Entity type:Individual
Prefix:MR
First Name:DARRYL
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MA, FA,AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13934 NORTH 59TH AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-4168
Mailing Address - Country:US
Mailing Address - Phone:602-866-0147
Mailing Address - Fax:602-547-9644
Practice Address - Street 1:13934 N 59TH AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4167
Practice Address - Country:US
Practice Address - Phone:602-866-0147
Practice Address - Fax:602-547-9644
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDA1308231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ26951Medicare ID - Type Unspecified