MEDICARE: CHRISTY 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	22008174A	IN

General Provider Information

NPI Number	:	1215633425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY JOHNSON

Provider Business Mailing Address
First Line	:	8296 N US HIGHWAY 27
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341-9508
Country	:	US
Telephone Number	:	765-725-0231
Fax Number	:

Provider Business Practice Location Address
First Line	:	8296 N US HIGHWAY 27
Second Line	:
City	:	FOUNTAIN CITY
State	:	IN
Zip	:	47341-9508
Country	:	US
Telephone Number	:	765-725-0231
Fax Number	:

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

Provider Enumeration Date	:	01/31/2023
Last Update Date	:	01/31/2023

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Directions to “ CHRISTY JOHNSON ” Practice Location

Language	Start Address	Practice Location

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