1568787018 NPI number — JENNIFER LYNN JOHNSON M.S.CCC-SLP

Table of content: JENNIFER LYNN JOHNSON M.S.CCC-SLP (NPI 1568787018)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568787018 NPI number — JENNIFER LYNN JOHNSON M.S.CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JENNIFER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.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:
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:
1568787018
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
376 PASCOE BLVD
Provider Second Line Business Mailing Address:
APT 22
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-5455
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-535-2639
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
376 PASCOE BLVD
Provider Second Line Business Practice Location Address:
APT 22
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42104-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-535-2639
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2010

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:  KY3383 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com