MEDICARE: DR. GLENN ALBERT JOHNSON PHD

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	LL00002989	WA

General Provider Information

NPI Number	:	1710929765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN ALBERT JOHNSON PHD

Provider Business Mailing Address
First Line	:	6828 30TH AVE NE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98115-7241
Country	:	US
Telephone Number	:	206-527-9105
Fax Number	:

Provider Business Practice Location Address
First Line	:	2611 NE 125TH ST
Second Line	:	SUITE 225
City	:	SEATTLE
State	:	WA
Zip	:	98125-4373
Country	:	US
Telephone Number	:	206-361-6884
Fax Number	:

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	05/24/2026

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Directions to “ DR. GLENN ALBERT JOHNSON PHD” Practice Location

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