Healthcare Provider Details

I. General information

NPI: 1215627401
Provider Name (Legal Business Name): CAROLINE HADDOX JOHNSON MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2023
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

463 E WASHINGTON ST
HARRISONBURG VA
22802-4853
US

IV. Provider business mailing address

1241 N MAIN ST
HARRISONBURG VA
22802-4632
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-3100
  • Fax: 540-434-0132
Mailing address:
  • Phone: 540-434-1941
  • Fax: 540-434-0132

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009924
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: