Provider Demographics
NPI:1124442793
Name:JOHNSON, JULIE M (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7448 KILBRITTAIN LN
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8280
Mailing Address - Country:US
Mailing Address - Phone:614-717-1888
Mailing Address - Fax:
Practice Address - Street 1:2730 ALTON DARBY CREEK RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-9770
Practice Address - Country:US
Practice Address - Phone:614-921-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 4682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist