Provider Demographics
NPI:1912422767
Name:JOHNSON, JAMES DANIEL (MS CF-SLP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DANIEL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 AMY CIR
Mailing Address - Street 2:
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-4117
Mailing Address - Country:US
Mailing Address - Phone:501-804-0658
Mailing Address - Fax:
Practice Address - Street 1:2201 N 50TH ST
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72904-5719
Practice Address - Country:US
Practice Address - Phone:479-785-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist