Provider Demographics
NPI:1386911261
Name:JOHNSON, KASEY COLLEEN (MS)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:COLLEEN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 DENISON PKWY W
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2613
Mailing Address - Country:US
Mailing Address - Phone:607-937-3200
Mailing Address - Fax:
Practice Address - Street 1:134 SENECA ST
Practice Address - Street 2:
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1324
Practice Address - Country:US
Practice Address - Phone:607-324-1303
Practice Address - Fax:607-324-6418
Is Sole Proprietor?:No
Enumeration Date:2011-11-21
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030165-01235Z00000X
2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist