Healthcare Provider Details

I. General information

NPI: 1639461353
Provider Name (Legal Business Name): LORI RUTH JOHNSON MA/CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2011
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1114 EASTCHESTER DR
HIGH POINT NC
27265-3114
US

IV. Provider business mailing address

23 SIDNEY MARIE CT
GREENSBORO NC
27407-6473
US

V. Phone/Fax

Practice location:
  • Phone: 336-802-1007
  • Fax: 336-888-3585
Mailing address:
  • Phone: 336-580-4845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number8123
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: