Doctor Name: | JENNA JOHNSON |
NPI Number: | 1154776136 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 3753 |
Business Practice Address: | 2035 Regency Rd Ste 5 Lexington, KY - 405032333 |
Business Phone Number: | 8594021553 |
Business Fax Number: | 8595146575 |
Mailing Address: | 125 Vincewood Dr, NICHOLASVILLE |
State: | KY |
Postal Code: | 403569342 |
Phone Number: | 8593121838 |
Fax Number: | |
NPI Enumeration Date: | 04/27/2016 |
NPI Last Update Date: | 04/27/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 3753 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | KY |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |