Healthcare Provider Details

I. General information

NPI: 1639085962
Provider Name (Legal Business Name): ERYN JOHNSON B.S., SLPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 TIGER DR
OAK GROVE LA
71263-8635
US

IV. Provider business mailing address

206 TIGER DR
OAK GROVE LA
71263-8635
US

V. Phone/Fax

Practice location:
  • Phone: 318-428-4810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number6620
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: