Provider Demographics
NPI:1598938854
Name:JOHNSON, KAREN WELLS (MA, CCC-SLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:WELLS
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:ELIZABETH
Other - Last Name:CHRISTOPHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3505 OLD JACKSONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8510
Mailing Address - Country:US
Mailing Address - Phone:903-561-7835
Mailing Address - Fax:903-561-9878
Practice Address - Street 1:3505 OLD JACKSONVILLE RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8510
Practice Address - Country:US
Practice Address - Phone:903-561-7835
Practice Address - Fax:903-561-9878
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100544235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist