Provider Demographics
NPI:1285133645
Name:JOHNSON, MOLLY JO (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:JO
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 W ATHENS CT
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:NE
Mailing Address - Zip Code:68339-3262
Mailing Address - Country:US
Mailing Address - Phone:402-981-1541
Mailing Address - Fax:
Practice Address - Street 1:600 S 1ST ST
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:NE
Practice Address - Zip Code:68347-5083
Practice Address - Country:US
Practice Address - Phone:402-781-2210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE616235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist