MEDICARE: TONDALAO DELEE JOHNSON M.S., CCC-A

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	231H00000X	Audiologist	267	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5502AP00151000	OTHER	CO	BLUE CROSS

General Provider Information

NPI Number	:	1538160346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONDALAO DELEE JOHNSON M.S., CCC-A

Provider Business Mailing Address
First Line	:	909 E EISENHOWER BLVD
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3923
Country	:	US
Telephone Number	:	970-593-9137
Fax Number	:	970-593-0232

Provider Business Practice Location Address
First Line	:	909 E EISENHOWER BLVD
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80537-3923
Country	:	US
Telephone Number	:	970-593-9137
Fax Number	:	970-593-9137

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

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	12/16/2010

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Directions to “ TONDALAO DELEE JOHNSON M.S., CCC-A” Practice Location

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