Provider Demographics
NPI:1932719358
Name:LAMBERT, JOHANNA MYA (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:MYA
Last Name:LAMBERT
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CASA LINDA LN
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9612
Mailing Address - Country:US
Mailing Address - Phone:831-345-1428
Mailing Address - Fax:
Practice Address - Street 1:163 CASA LINDA LN
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-9612
Practice Address - Country:US
Practice Address - Phone:831-345-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-01
Last Update Date:2020-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24421235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist