MEDICARE: MICHAELA J JOHNSON CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	7627	TN
2	235Z00000X	Speech-Language Pathologist	5038-154	WI

General Provider Information

NPI Number	:	1063023414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAELA J JOHNSON CCC-SLP

Provider Business Mailing Address
First Line	:	1924 ALCOA HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1511
Country	:	US
Telephone Number	:	865-305-9151
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 ALCOA HWY
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-6900
Country	:	US
Telephone Number	:	513-551-6317
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2020
Last Update Date	:	01/05/2024

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Directions to “ MICHAELA J JOHNSON CCC-SLP” Practice Location

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