Healthcare Provider Details

I. General information

NPI: 1750210738
Provider Name (Legal Business Name): ELIZABETH ANN JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 05/16/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 ANTIQUE CITY DR
WALNUT IA
51577-2002
US

IV. Provider business mailing address

2229 200TH ST
MARNE IA
51552-2002
US

V. Phone/Fax

Practice location:
  • Phone: 712-254-2072
  • Fax:
Mailing address:
  • Phone: 712-254-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number088162
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: