Provider Demographics
NPI:1720327661
Name:JOHNSON, JEFFREY EUGENE
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:EUGENE
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 E EISENHOWER BLVD
Mailing Address - Street 2:#101
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3949
Mailing Address - Country:US
Mailing Address - Phone:970-593-9137
Mailing Address - Fax:970-593-0232
Practice Address - Street 1:909 E EISENHOWER BLVD
Practice Address - Street 2:#101
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3949
Practice Address - Country:US
Practice Address - Phone:970-593-9137
Practice Address - Fax:970-593-0232
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHAD.0000012237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist