MEDICARE: AMY CHRISTINE JOHNSON 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	10399	CA

General Provider Information

NPI Number	:	1316722341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY CHRISTINE JOHNSON SLP

Provider Business Mailing Address
First Line	:	3436 N VERDUGO RD STE 101
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1546
Country	:	US
Telephone Number	:	818-330-7272
Fax Number	:	818-330-7262

Provider Business Practice Location Address
First Line	:	3436 N VERDUGO RD STE 101
Second Line	:
City	:	GLENDALE
State	:	CA
Zip	:	91208-1546
Country	:	US
Telephone Number	:	818-330-7272
Fax Number	:	818-330-7262

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

Provider Enumeration Date	:	08/28/2023
Last Update Date	:	08/28/2023

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