Provider Demographics
NPI:1952486490
Name:JOHNSON, HEATHER BREWER (MS CCC/SLP)
Entity type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:BREWER
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS 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:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:CAMPTON
Mailing Address - State:KY
Mailing Address - Zip Code:41301-0975
Mailing Address - Country:US
Mailing Address - Phone:606-668-7938
Mailing Address - Fax:
Practice Address - Street 1:4516 KY 15 NORTH
Practice Address - Street 2:
Practice Address - City:PINE RIDGE
Practice Address - State:KY
Practice Address - Zip Code:41360
Practice Address - Country:US
Practice Address - Phone:606-668-7938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY143032235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist