Provider Demographics
NPI:1700177920
Name:JOHNSON, DARRELL D
Entity Type:Individual
Prefix:
First Name:DARRELL
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5750 BALCONES DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4252
Mailing Address - Country:US
Mailing Address - Phone:512-836-8786
Mailing Address - Fax:512-836-8794
Practice Address - Street 1:5750 BALCONES DR
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4252
Practice Address - Country:US
Practice Address - Phone:512-836-8786
Practice Address - Fax:512-836-8794
Is Sole Proprietor?:No
Enumeration Date:2011-04-21
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX50241231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80733AOtherBCBS - AENTC
TX80734AOtherBCBS - HCAENTC
TX80733AOtherBCBS - AENTC