MEDICARE: MRS. LESLIE MARTIN JOHNSON M.S, 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	SLP002048	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265449789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LESLIE MARTIN JOHNSON M.S, CCC-SLP

Provider Business Mailing Address
First Line	:	604 BUCKSHOT CT
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-4496
Country	:	US
Telephone Number	:	912-764-7833
Fax Number	:	912-764-7833

Provider Business Practice Location Address
First Line	:	604 BUCKSHOT CT
Second Line	:
City	:	STATESBORO
State	:	GA
Zip	:	30461-4496
Country	:	US
Telephone Number	:	912-764-7833
Fax Number	:	912-764-7833

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/09/2007

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Directions to “ MRS. LESLIE MARTIN JOHNSON M.S, CCC-SLP” Practice Location

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