Provider Demographics
NPI:1194896225
Name:JOHNSON, LAURA MCMURRAY (MA CCC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:MCMURRAY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2326 BROOKWAY DR
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-1719
Mailing Address - Country:US
Mailing Address - Phone:630-232-2428
Mailing Address - Fax:630-305-0683
Practice Address - Street 1:932 N WRIGHT ST
Practice Address - Street 2:SUITE 128
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-3600
Practice Address - Country:US
Practice Address - Phone:630-305-0593
Practice Address - Fax:630-305-0683
Is Sole Proprietor?:No
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist