| Doctor Name: | STACY JOHNSON |
| NPI Number: | 1619273463 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M,S., CCC-SLP |
| License Number: | 18545 |
| Business Practice Address: | 424 N Lake Ave Suite 302 Pasadena, CA - 911011200 |
| Business Phone Number: | 6267939444 |
| Business Fax Number: | |
| Mailing Address: | 1159 Linden Ave, Apt 6 GLENDALE |
| State: | CA |
| Postal Code: | 912011569 |
| Phone Number: | 9095734982 |
| Fax Number: | |
| NPI Enumeration Date: | 01/26/2011 |
| NPI Last Update Date: | 01/26/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 18545 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| 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 |