Healthcare Provider Details

I. General information

NPI: 1245475425
Provider Name (Legal Business Name): LAURA DENISE JOHNSON M.ED., CCC/SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 SAFRIT DR
BEAUFORT NC
28516-9017
US

IV. Provider business mailing address

600 DEEP FOREST LN
ARCHER LODGE NC
27527-6270
US

V. Phone/Fax

Practice location:
  • Phone: 252-728-4583
  • Fax:
Mailing address:
  • Phone: 919-333-8545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12116016
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: