Provider Demographics
NPI:1356127971
Name:JOHNSTON, REBECCA (SLPA)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 EARL RUDDER FWY S STE 1200
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-2810
Mailing Address - Country:US
Mailing Address - Phone:713-513-0614
Mailing Address - Fax:
Practice Address - Street 1:2700 EARL RUDDER FWY S STE 1200
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-2810
Practice Address - Country:US
Practice Address - Phone:713-513-0614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX43322235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist