MEDICARE: BREANNA LYNN 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	30004826	NC
2	235Z00000X	Speech-Language Pathologist	112860	TX

General Provider Information

NPI Number	:	1134621675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BREANNA LYNN JOHNSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5411 JAIN LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78721-3022
Country	:	US
Telephone Number	:	512-940-7865
Fax Number	:

Provider Business Practice Location Address
First Line	:	3520 EXECUTIVE CENTER DR STE 128
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78731-1636
Country	:	US
Telephone Number	:	612-343-0222
Fax Number	:

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

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	03/05/2026

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Directions to “ BREANNA LYNN JOHNSON M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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