MEDICARE: STEPHANIE MARIE JOHNSON MA CCCSLP

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	100073	TX

General Provider Information

NPI Number	:	1437369675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARIE JOHNSON MA CCCSLP

Provider Business Mailing Address
First Line	:	6410 FANNIN ST STE 1400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5389
Country	:	US
Telephone Number	:	713-500-7302
Fax Number	:	888-876-2741

Provider Business Practice Location Address
First Line	:	6410 FANNIN ST STE 1400
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77030-5389
Country	:	US
Telephone Number	:	713-500-7302
Fax Number	:	888-876-2741

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	06/05/2025

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