MEDICARE: KARRIE MICHELLE 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	18549	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1699153700	OTHER	CA	NPI

General Provider Information

NPI Number	:	1477095354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARRIE MICHELLE JOHNSON M.S CCC-SLP

Provider Business Mailing Address
First Line	:	2445 TRUXTUN RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6154
Country	:	US
Telephone Number	:	619-633-2119
Fax Number	:	619-633-2120

Provider Business Practice Location Address
First Line	:	2445 TRUXTUN RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-6154
Country	:	US
Telephone Number	:	619-633-2119
Fax Number	:	619-633-2120

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

Provider Enumeration Date	:	11/09/2016
Last Update Date	:	08/08/2022

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