Individual
MRS. TIA L JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
555 E BROADWAY AVE # 100, JACKSON, WY 83001-8640
(307) 739-1864
Mailing address
555 E BROADWAY AVE # 100, JACKSON, WY 83001-8640
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP-1039
WY
Other
Enumeration date
06/16/2021
Last updated
06/16/2021
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