Individual
AMANDA L JOHANNSSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
109 TROUP ST, ROCHESTER, NY 14608-2027
(315) 717-9191
Mailing address
109 TROUP ST, ROCHESTER, NY 14608-2027
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
021864-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14060744
AMERICAN SPEECH-LANGUAGE HEARING ASSOCIATION CERIFICATION
NY
Enumeration date
06/03/2012
Last updated
06/03/2012
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