MEDICARE: JENNIFER ANNE JOHNSON

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	013045-1	NY

General Provider Information

NPI Number	:	1164667358
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ANNE JOHNSON

Provider Business Mailing Address
First Line	:	633 ROBIN CT
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3847
Country	:	US
Telephone Number	:	516-414-6776
Fax Number	:

Provider Business Practice Location Address
First Line	:	633 ROBIN CT
Second Line	:
City	:	WEST HEMPSTEAD
State	:	NY
Zip	:	11552-3847
Country	:	US
Telephone Number	:	516-414-6776
Fax Number	:

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

Provider Enumeration Date	:	12/02/2008
Last Update Date	:	12/02/2008

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Directions to “ JENNIFER ANNE JOHNSON ” Practice Location

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