| Doctor Name: | CONNIE M. JOHANSEN |
| NPI Number: | 1548339401 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSCCCSLP |
| License Number: | SLP001627 |
| Business Practice Address: | 2403 Battlefield Pkwy Fort Oglethorpe, GA - 307424033 |
| Business Phone Number: | 7068667700 |
| Business Fax Number: | |
| Mailing Address: | 1119 Gnome Trl, LOOKOUT MTN |
| State: | GA |
| Postal Code: | 307502811 |
| Phone Number: | 7068207622 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | SLP001627 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| 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 |