MEDICARE: MARTHA PEARL JOHNSON M.S. CCC-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
1	235Z00000X	Speech-Language Pathologist	168824	AK

General Provider Information

NPI Number	:	1871913376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTHA PEARL JOHNSON M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2440 E TUDOR RD PMB 163
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99507-1185
Country	:	US
Telephone Number	:	907-213-0517
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 UNIVERSITY DR
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99508-4625
Country	:	US
Telephone Number	:	210-219-9084
Fax Number	:

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

Provider Enumeration Date	:	04/23/2014
Last Update Date	:	01/21/2025

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