Provider Demographics
NPI:1336260405
Name:JOHANSON, CHRISTINA A (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:A
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:NINA
Other - Middle Name:AYD
Other - Last Name:JOHANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, MS, CCC-SLP, CLC
Mailing Address - Street 1:2011 OLD FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-4119
Mailing Address - Country:US
Mailing Address - Phone:410-804-2568
Mailing Address - Fax:
Practice Address - Street 1:2011 OLD FREDERICK RD
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4119
Practice Address - Country:US
Practice Address - Phone:410-804-2568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02987235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist