Healthcare Provider Details

I. General information

NPI: 1386911261
Provider Name (Legal Business Name): KASEY COLLEEN JOHNSON MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 12/04/2020
Certification Date: 12/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 SENECA ST
HORNELL NY
14843-1324
US

IV. Provider business mailing address

33 DENISON PKWY W
CORNING NY
14830-2613
US

V. Phone/Fax

Practice location:
  • Phone: 607-324-1303
  • Fax: 607-324-6418
Mailing address:
  • Phone: 607-937-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number030165-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: