Doctor Name: | ANGELA MARIE JOHNSON |
NPI Number: | 1730322264 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S. |
License Number: | |
Business Practice Address: | 611 S Marshall Ave # 429 Mc Leansboro, IL - 628591213 |
Business Phone Number: | 6186435556 |
Business Fax Number: | |
Mailing Address: | 660 Grayson Rd, ELDORADO |
State: | IL |
Postal Code: | 629303903 |
Phone Number: | 6188411363 |
Fax Number: | |
NPI Enumeration Date: | 04/14/2009 |
NPI Last Update Date: | 01/11/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
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 |