Individual
KIMBERLY ANN JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CCC/SLP
Contact information
Practice address
9244 BIORKA CIR, EAGLE RIVER, AK 99577-8619
(907) 240-9970
Mailing address
9244 BIORKA CIR, EAGLE RIVER, AK 99577-8619
(907) 240-9970
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
197
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01098951
ASHA NATIONAL CERTIFICATION
—
01
—
SLPS 197
PROFESSIONAL BUSINESS LICENSE
AK
Enumeration date
08/14/2014
Last updated
08/14/2014
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