Individual
CASSIE DAWN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
6721 S LUNAR AVE, BOISE, ID 83709-7870
(208) 859-8372
Mailing address
6721 S LUNAR AVE, BOISE, ID 83709-7870
(208) 859-8372
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP-1183
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SPH05
BCBS OF IDAHO PIN ID
ID
Enumeration date
12/01/2006
Last updated
07/08/2007
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