1376663484 NPI number — GOLD STAR SPEECH THERAPY, P.C.

Table of content: MRS. KAREN ELIZABETH JOHNSON PT (NPI 1912030602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376663484 NPI number — GOLD STAR SPEECH THERAPY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLD STAR SPEECH THERAPY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376663484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
236 BERKSHIRE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60554-9479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-605-9391
Provider Business Mailing Address Fax Number:
630-466-3735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
236 BERKSHIRE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60554-9479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-605-9391
Provider Business Practice Location Address Fax Number:
630-466-3735
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STREICHER
Authorized Official First Name:
AIMEE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
SPEECH-LANGUAGE PATHOLOGIST
Authorized Official Telephone Number:
630-605-9391

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4532028 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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