Provider Demographics
NPI:1952699779
Name:JOHNSON, ERIN LEE (AUD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3153 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6717
Mailing Address - Country:US
Mailing Address - Phone:208-529-4969
Mailing Address - Fax:208-529-6976
Practice Address - Street 1:3153 E 17TH ST
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6717
Practice Address - Country:US
Practice Address - Phone:208-529-4969
Practice Address - Fax:208-529-6976
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2011-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDAUD-2125231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist