Doctor Name: | KELLY JOHNSON |
NPI Number: | 1811399447 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | SP20669 |
Business Practice Address: | 1972 Del Paso Rd Suite 156 Sacramento, CA - 958347724 |
Business Phone Number: | 9165758800 |
Business Fax Number: | |
Mailing Address: | 7316 Rochelle Way, FAIR OAKS |
State: | CA |
Postal Code: | 956284332 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/26/2014 |
NPI Last Update Date: | 09/26/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SP20669 |
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 |