Healthcare Provider Details

I. General information

NPI: 1609446699
Provider Name (Legal Business Name): HANNAH JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 10TH AVE
FAIRBANKS AK
99701-5003
US

IV. Provider business mailing address

102 10TH AVE
FAIRBANKS AK
99701-5003
US

V. Phone/Fax

Practice location:
  • Phone: 907-415-9331
  • Fax:
Mailing address:
  • Phone: 907-415-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number258033
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: