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General NPI Number Information
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NPI Number | 1407339419
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Entity Type | Individual
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Provider Name | SAMANTHA JO JOHNSON BS, SLP-A
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Gender | Female
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Dates
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Enumeration Date | 09/14/2018
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Last Update Date | 09/14/2018
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Provider Practice Location Address
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Address Line | 602 W SEMANDS ST
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City | CONROE
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State | TX
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Zip | 77301-1867
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Country | US
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Telephone | 936-756-5598
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Fax | 936-249-2244
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Provider Business Mailing Address
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Address Line | 21899 VALLEY RANCH CROSSING DR APT 334
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City | PORTER
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State | TX
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Zip | 77365-7307
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Country | US
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Telephone | 936-615-5985
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number | 40554
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License Number State | TX
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