Healthcare Provider Details

I. General information

NPI: 1366937997
Provider Name (Legal Business Name): SARAH DIANE JOHNSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2018
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2746 SUPERIOR DR NW
ROCHESTER MN
55901-8343
US

IV. Provider business mailing address

411 2ND ST NW
STEWARTVILLE MN
55976-1135
US

V. Phone/Fax

Practice location:
  • Phone: 507-288-0064
  • Fax:
Mailing address:
  • Phone: 507-475-1495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number9967
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: