Provider Demographics
NPI:1194982504
Name:JOHNSON, JAMES WILLIAM (MS CCCA)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MS CCCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2385 E PRATER WAY
Mailing Address - Street 2:ADVANCE AUDIOLOGY
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89434-7688
Mailing Address - Country:US
Mailing Address - Phone:775-358-4007
Mailing Address - Fax:775-358-4405
Practice Address - Street 1:2385 E PRATER WAY SUITE 205
Practice Address - Street 2:ADVANCE AUDIOLOGY
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89434-7688
Practice Address - Country:US
Practice Address - Phone:775-358-4007
Practice Address - Fax:775-358-4405
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00686394231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist