Healthcare Provider Details

I. General information

NPI: 1619887858
Provider Name (Legal Business Name): CARYN LYNN JOHNSTON CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5102 N STONY CREEK RD
MONROE MI
48162-9158
US

IV. Provider business mailing address

1101 S RAISINVILLE RD
MONROE MI
48161-9047
US

V. Phone/Fax

Practice location:
  • Phone: 734-289-5565
  • Fax:
Mailing address:
  • Phone: 734-322-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number7101006447
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: