Individual
LORI JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
5401 GLENRIO RD NW, JOHN ADAMS MS, ALBUQUERQUE, NM 87105-1273
(505) 831-0400
Mailing address
5401 GLENRIO RD NW, JOHN ADAMS MS, ALBUQUERQUE, NM 87105-1273
(505) 831-0400
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
4047
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00000
NO MEDICAID # YET
—
Enumeration date
04/18/2007
Last updated
07/08/2007
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