Healthcare Provider Details

I. General information

NPI: 1649620022
Provider Name (Legal Business Name): KATHLEEN JOHNSON M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 02/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 EUCLID AVE SUITE 4
HELENA MT
59601-2100
US

IV. Provider business mailing address

1325 EUCLID AVE SUITE 4
HELENA MT
59601-2100
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-3330
  • Fax: 406-443-5215
Mailing address:
  • Phone: 406-443-3330
  • Fax: 406-443-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberSLP-AU-LIC-369
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number369
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: