Healthcare Provider Details

I. General information

NPI: 1649847526
Provider Name (Legal Business Name): BRANDI JOHNSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2021
Last Update Date: 10/22/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24044 CINCO VILLAGE CENTER BLVD STE 100
KATY TX
77494-8433
US

IV. Provider business mailing address

9819 KNIGHTS DR
HOUSTON TX
77065-4340
US

V. Phone/Fax

Practice location:
  • Phone: 832-831-0043
  • Fax: 832-200-2266
Mailing address:
  • Phone: 281-222-6774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number118055
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: