MEDICARE: MRS. CHRISTINA BOWLING JOHNSON M.S., CCC-SLP

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	5439	NC

General Provider Information

NPI Number	:	1124375456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHRISTINA BOWLING JOHNSON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2611 HAVENTREE CT
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27502-6297
Country	:	US
Telephone Number	:	919-593-8104
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 NATIONAL DR STE 219
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27612-4842
Country	:	US
Telephone Number	:	919-593-8104
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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Directions to “ MRS. CHRISTINA BOWLING JOHNSON M.S., CCC-SLP” Practice Location

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