Provider Demographics
NPI:1841499159
Name:JOHNSON, RACHEL K (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:K
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 READE PL
Mailing Address - Street 2:SPEECH-LANGUAGE PATHOLOGY
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3947
Mailing Address - Country:US
Mailing Address - Phone:845-483-6381
Mailing Address - Fax:845-483-6036
Practice Address - Street 1:45 READE PL
Practice Address - Street 2:SPEECH-LANGUAGE PATHOLOGY
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3947
Practice Address - Country:US
Practice Address - Phone:845-483-6381
Practice Address - Fax:845-483-6036
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9059235Z00000X
NY017252-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist