1881656320 NPI number — MS. SHARON ELIZABETH JOHNSON M.A., CCC-A

Table of content: MS. SHARON ELIZABETH JOHNSON M.A., CCC-A (NPI 1881656320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881656320 NPI number — MS. SHARON ELIZABETH JOHNSON M.A., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
SHARON
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., CCC-A
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:
1881656320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
920 E 1ST ST
Provider Second Line Business Mailing Address:
SUITE 301
Provider Business Mailing Address City Name:
DULUTH
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55805-2201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
218-279-6279
Provider Business Mailing Address Fax Number:
218-279-6280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 E 1ST ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55805-2201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
218-279-6279
Provider Business Practice Location Address Fax Number:
218-279-6280
Provider Enumeration Date:
04/03/2006

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: 231H00000X , with the licence number:  5336 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 614009 . This is a "ARAZ" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 46A09J0 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 00045927 . This is a "RAILROAD RETIREMENT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 1013454 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 45-0-0005 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 06238 . This is a "NATIONAL EAR CARE PLAN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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