Provider Demographics
NPI:1982707303
Name:JOHNSON, RICHARD (AU D)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9770 S MCCARRAN BLVD
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523
Mailing Address - Country:US
Mailing Address - Phone:775-322-4589
Mailing Address - Fax:775-322-3787
Practice Address - Street 1:9770 S MCCARRAN BLVD
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523
Practice Address - Country:US
Practice Address - Phone:775-322-4589
Practice Address - Fax:775-322-3787
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV003416146Medicaid