Provider Demographics
NPI:1982948964
Name:DEVIN, JOHNNA CHRISTEEN (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:JOHNNA
Middle Name:CHRISTEEN
Last Name:DEVIN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:MRS
Other - First Name:JOHNNA
Other - Middle Name:CHRISTEEN
Other - Last Name:UPTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, CCC-SLP
Mailing Address - Street 1:3724 BOSKYDELL RD
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62903-7624
Mailing Address - Country:US
Mailing Address - Phone:618-351-6574
Mailing Address - Fax:
Practice Address - Street 1:306 W MILL ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:IL
Practice Address - Zip Code:62901-2727
Practice Address - Country:US
Practice Address - Phone:618-529-3060
Practice Address - Fax:618-457-5372
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.005510235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist