Provider Demographics
NPI:1215770391
Name:JOHNSON, TRISTAN LORAN (AUD)
Entity type:Individual
Prefix:
First Name:TRISTAN
Middle Name:LORAN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 10TH AVE NE STE C
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-3882
Mailing Address - Country:US
Mailing Address - Phone:828-322-2183
Mailing Address - Fax:828-322-7279
Practice Address - Street 1:304 10TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-3883
Practice Address - Country:US
Practice Address - Phone:828-322-2183
Practice Address - Fax:828-322-7279
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30003067231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist