Provider Demographics
NPI:1538588876
Name:JOHNSTON, ANN MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:MARIE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 PURCELL PL
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-3468
Mailing Address - Country:US
Mailing Address - Phone:585-719-6075
Mailing Address - Fax:
Practice Address - Street 1:975 PLATTE RIVER BLVD
Practice Address - Street 2:UNIT O
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4349
Practice Address - Country:US
Practice Address - Phone:303-659-8822
Practice Address - Fax:303-659-7788
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-15
Last Update Date:2014-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSLP 0001658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist