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NPI Code Detail

MEDICARE: DAMITRA JOHNSON

MEDICARE: DAMITRA 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
1235Z00000XSpeech-Language Pathologist118057TX

General Provider Information

NPI Number : 1427624279
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMITRA JOHNSON
Provider Business Mailing Address
First Line : 12807 TELGE RD APT 2329
Second Line :
City : CYPRESS
State : TX
Zip : 77429-1456
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2520 WW THORNE BLVD
Second Line :
City : HOUSTON
State : TX
Zip : 77073-3406
Country : US
Telephone Number : 281-449-1011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2021
Last Update Date : 09/16/2022

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Directions to “ DAMITRA JOHNSON ” Practice Location

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