Provider Demographics
NPI:1912487778
Name:JOHNSON, LAUREN MARA (MS-SLP)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARA
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 1:4043 OVERLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66049-4122
Mailing Address - Country:US
Mailing Address - Phone:801-885-4040
Mailing Address - Fax:
Practice Address - Street 1:600 PERRY ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66533-9784
Practice Address - Country:US
Practice Address - Phone:785-584-6104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist