Provider Demographics
NPI:1154156479
Name:JOHNSON, ALICIA (CCC SLP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 RUSSELL DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:AL
Mailing Address - Zip Code:35503-3551
Mailing Address - Country:US
Mailing Address - Phone:120-521-2067
Mailing Address - Fax:205-387-0567
Practice Address - Street 1:745 RUSSELL DAIRY RD
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:AL
Practice Address - Zip Code:35503-3551
Practice Address - Country:US
Practice Address - Phone:205-387-0562
Practice Address - Fax:205-387-8210
Is Sole Proprietor?:No
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5348224Z00000X
AL2759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant