Provider Demographics
NPI:1831192509
Name:JOHANSON, SHERYL (MED CCC A, FAAA)
Entity type:Individual
Prefix:MS
First Name:SHERYL
Middle Name:
Last Name:JOHANSON
Suffix:
Gender:F
Credentials:MED CCC A, FAAA
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 245
Mailing Address - Street 2:
Mailing Address - City:FOUNTAINVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18923-0245
Mailing Address - Country:US
Mailing Address - Phone:215-345-4544
Mailing Address - Fax:215-345-9145
Practice Address - Street 1:5033 SWAMP RD
Practice Address - Street 2:STE 502
Practice Address - City:FOUNTAINVILLE
Practice Address - State:PA
Practice Address - Zip Code:18923-9606
Practice Address - Country:US
Practice Address - Phone:215-345-4544
Practice Address - Fax:215-345-9145
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000563L231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0256242000OtherKEYSTONE EAST
PA2082374OtherUSHC/AETNA
PA202608 MZRMedicare ID - Type Unspecified
PA0256242000OtherKEYSTONE EAST