Provider Demographics
NPI:1194270793
Name:JOHNSON, CIARA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:CIARA
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
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 1:1308 VERMEER DR
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-4464
Mailing Address - Country:US
Mailing Address - Phone:941-993-2067
Mailing Address - Fax:
Practice Address - Street 1:1308 VERMEER DR
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-4464
Practice Address - Country:US
Practice Address - Phone:941-993-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15580235Z00000X
FLSZ7753235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL018605300Medicaid
FLSZ7753OtherFLORIDA DEPARTMENT OF HEALTH
FL15580OtherFLORIDA DEPARTMENT OF HEALTH