Provider Demographics
NPI:1831501154
Name:JOHNSON, KATHRYN (MS SLP)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:874 11TH ST
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-5058
Mailing Address - Country:US
Mailing Address - Phone:208-244-2882
Mailing Address - Fax:208-528-2808
Practice Address - Street 1:874 11TH ST
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-5058
Practice Address - Country:US
Practice Address - Phone:208-244-2882
Practice Address - Fax:208-528-2808
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist