Provider Demographics
NPI:1316174592
Name:JOHNSTON, JANE ANN (MS, SLP/CCC)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ANN
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MS, SLP/CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1452
Mailing Address - Street 2:
Mailing Address - City:SARATOGA
Mailing Address - State:WY
Mailing Address - Zip Code:82331-1452
Mailing Address - Country:US
Mailing Address - Phone:307-329-8398
Mailing Address - Fax:
Practice Address - Street 1:1210 SOUTH RIVER
Practice Address - Street 2:
Practice Address - City:SARATOGA
Practice Address - State:WY
Practice Address - Zip Code:82331-1452
Practice Address - Country:US
Practice Address - Phone:307-329-8398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYSP-033235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist