1922067602 NPI number — MRS. VALERIE LEIGH JOHNSTON MS CCC SLP

Table of content: MRS. VALERIE LEIGH JOHNSTON MS CCC SLP (NPI 1922067602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922067602 NPI number — MRS. VALERIE LEIGH JOHNSTON MS CCC SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
VALERIE
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS CCC SLP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JENKINS
Provider Other First Name:
VALERIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922067602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4400 PERRY LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-346-6515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4763 BARWICK DR
Provider Second Line Business Practice Location Address:
#103 OVERTON SPEECH AND LANGUAGE CENTER
Provider Business Practice Location Address City Name:
FORTH WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-294-8408
Provider Business Practice Location Address Fax Number:
817-294-8411
Provider Enumeration Date:
03/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  102222 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10222 . This is a "TEXAS DEPT OF STATE HEALT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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