MEDICARE: ZAKIE 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	2355S0801X	Speech-Language Assistant	SI3871	FL

General Provider Information

NPI Number	:	1598228942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ZAKIE JOHNSON

Provider Business Mailing Address
First Line	:	PO BOX 221814
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33022-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 SE 3RD AVE # F10
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33394-0002
Country	:	US
Telephone Number	:	954-417-3792
Fax Number	:

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

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	12/21/2021

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Directions to “ ZAKIE JOHNSON ” Practice Location

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