Healthcare Provider Details

I. General information

NPI: 1598938854
Provider Name (Legal Business Name): KAREN WELLS JOHNSON M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN ELIZABETH CHRISTOPHER

II. Dates (important events)

Enumeration Date: 04/08/2008
Last Update Date: 08/20/2024
Certification Date: 08/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 OLD JACKSONVILLE RD
TYLER TX
75701-8510
US

IV. Provider business mailing address

3505 OLD JACKSONVILLE RD
TYLER TX
75701-8510
US

V. Phone/Fax

Practice location:
  • Phone: 903-561-7835
  • Fax: 903-561-9878
Mailing address:
  • Phone: 903-561-7835
  • Fax: 903-561-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number100544
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: