Provider Demographics
NPI:1285964619
Name:JOHNSTON, LAURA LEE (MSCCC-SLP)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:LEE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MSCCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7912 MABELVALE PIKE
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-3353
Mailing Address - Country:US
Mailing Address - Phone:501-570-0904
Mailing Address - Fax:501-570-0954
Practice Address - Street 1:7912 MABELVALE PIKE
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-3353
Practice Address - Country:US
Practice Address - Phone:501-570-0904
Practice Address - Fax:501-570-0954
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist