Provider Demographics
NPI:1649493594
Name:JOHNSON, JASON COURTNEY (SLP)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:COURTNEY
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16314 FLINT RUN WAY
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-7109
Mailing Address - Country:US
Mailing Address - Phone:281-277-7096
Mailing Address - Fax:
Practice Address - Street 1:16314 FLINT RUN WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-7109
Practice Address - Country:US
Practice Address - Phone:281-277-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102195235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist