Provider Demographics
NPI:1700161429
Name:JOHNSTON, JEFFREY JAY (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAY
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6804 GREEN BAY ROAD
Mailing Address - Street 2:113
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8458
Mailing Address - Country:US
Mailing Address - Phone:262-577-5577
Mailing Address - Fax:262-577-5511
Practice Address - Street 1:6804 GREEN BAY ROAD
Practice Address - Street 2:113
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142
Practice Address - Country:US
Practice Address - Phone:262-577-5577
Practice Address - Fax:262-577-5511
Is Sole Proprietor?:No
Enumeration Date:2011-10-13
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1310060237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist