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NPI Code Detail

MEDICARE: SARA B JOHNSON SLP

MEDICARE: SARA B 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
1235Z00000XSpeech-Language Pathologist22003600AIN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1649490640
Entity Type Code : Individual
Provider Name (Legal Business Name) : SARA B JOHNSON SLP
Provider Business Mailing Address
First Line : 4935 HILLEGAS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1934
Country : US
Telephone Number : 260-338-1241
Fax Number :
Provider Business Practice Location Address
First Line : 4935 HILLEGAS RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46818-1934
Country : US
Telephone Number : 260-338-1241
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 10/02/2018

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Directions to “ SARA B JOHNSON SLP” Practice Location

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