Provider Demographics
NPI:1356128078
Name:JOHNSON, MICHAELA LYNN (SLP)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9115 DREXEL CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68127-4461
Mailing Address - Country:US
Mailing Address - Phone:402-681-3405
Mailing Address - Fax:
Practice Address - Street 1:1307 ROGERS DR
Practice Address - Street 2:
Practice Address - City:PAPILLION
Practice Address - State:NE
Practice Address - Zip Code:68046-6143
Practice Address - Country:US
Practice Address - Phone:402-898-0469
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE236Medicaid
NE5874OtherHEALTH PARTNERS
NE568946544OtherBCBS