Provider Demographics
NPI:1952749079
Name:JOHNSON, ANN KATHERINE (MS, CF-SLP)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:KATHERINE
Last Name:JOHNSON
Suffix:
Gender:F
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 1:115 N YAKIMA AVE
Mailing Address - Street 2:#403
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98403-2239
Mailing Address - Country:US
Mailing Address - Phone:815-382-0913
Mailing Address - Fax:
Practice Address - Street 1:320 176TH ST E
Practice Address - Street 2:
Practice Address - City:SPANAWAY
Practice Address - State:WA
Practice Address - Zip Code:98387-8322
Practice Address - Country:US
Practice Address - Phone:253-683-7400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60320117235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist