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Individual

KATIE JOHNSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
4419 W PECAN ST, FAYETTEVILLE, AR 72704-7909
(870) 688-1308
Mailing address
4419 W PECAN ST, FAYETTEVILLE, AR 72704-7909
(870) 688-1308

Taxonomy

Speciality
Code
Description
License number
State
2355S0801X
Speech-Language Assistant
Primary
235580801X
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
116141743
OUR COOP
AR
Enumeration date
12/12/2014
Last updated
12/12/2014
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