Healthcare Provider Details

I. General information

NPI: 1740947167
Provider Name (Legal Business Name): SYDNEY JOHNSON M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 E KIMBROUGH ST
MESQUITE TX
75149-4420
US

IV. Provider business mailing address

12111 FALCON RD
CRANDALL TX
75114-5209
US

V. Phone/Fax

Practice location:
  • Phone: 972-882-7700
  • Fax:
Mailing address:
  • Phone: 972-365-4234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number121535
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: