Provider Demographics
NPI:1194508879
Name:JOHNSON, KIRSTEN DANIELLE (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:DANIELLE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CONCORD TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-4247
Mailing Address - Country:US
Mailing Address - Phone:636-980-6785
Mailing Address - Fax:
Practice Address - Street 1:1155 JUNGS STATION RD
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-6010
Practice Address - Country:US
Practice Address - Phone:636-851-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023033527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist