Provider Demographics
NPI:1316166119
Name:JOHNSON, ELIZABETH JULIA
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:JULIA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3111 NORTHRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81506-1921
Mailing Address - Country:US
Mailing Address - Phone:970-243-4614
Mailing Address - Fax:
Practice Address - Street 1:3111 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81506-1921
Practice Address - Country:US
Practice Address - Phone:970-243-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58055258Medicaid