MEDICARE: ELLEN JOHANSING CCC-SLP, M.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	115218	TX

General Provider Information

NPI Number	:	1043684731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN JOHANSING CCC-SLP, M.S.

Provider Business Mailing Address
First Line	:	802 MONTANA ST APT 1
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78203-1164
Country	:	US
Telephone Number	:	415-317-1194
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 WURZBACH RD STE 700
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4332
Country	:	US
Telephone Number	:	210-737-8090
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/19/2015
Last Update Date	:	05/06/2019

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Directions to “ ELLEN JOHANSING CCC-SLP, M.S.” Practice Location

Language	Start Address	Practice Location

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