MEDICARE: AMANDA 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	235Z00000X	Speech-Language Pathologist	109167	TX

General Provider Information

NPI Number	:	1801478904
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA JOHNSON

Provider Business Mailing Address
First Line	:	1002 CEDAR LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5909
Country	:	US
Telephone Number	:	469-644-1650
Fax Number	:

Provider Business Practice Location Address
First Line	:	1002 CEDAR LN
Second Line	:
City	:	RICHARDSON
State	:	TX
Zip	:	75080-5909
Country	:	US
Telephone Number	:	469-644-1650
Fax Number	:

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

Provider Enumeration Date	:	04/27/2021
Last Update Date	:	04/27/2021

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Directions to “ AMANDA JOHNSON ” Practice Location

Language	Start Address	Practice Location

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